Provider Demographics
NPI:1366877854
Name:GRANVILLE, LEATISHER R (LPCC)
Entity type:Individual
Prefix:MRS
First Name:LEATISHER
Middle Name:R
Last Name:GRANVILLE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MULL AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7502
Mailing Address - Country:US
Mailing Address - Phone:330-867-5603
Mailing Address - Fax:330-873-3439
Practice Address - Street 1:900 MULL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7502
Practice Address - Country:US
Practice Address - Phone:330-867-5603
Practice Address - Fax:330-873-3439
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0900211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health