Anisa D Grantham, LPC, NCAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

004189 Issued in GA

Practice address

613 Towne Park Dr W Ste 103
Rincon, GA 31326-9098

Phone

(912) 826-0918

Fax

(912) 826-0959

NPI assigned

Jan 31, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436832000000",
    "number": "1619014255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 TOWNE PARK DR W STE 103",
            "address_2": "PO BOX 1834",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313269098",
            "telephone_number": "912-826-0918",
            "fax_number": "912-826-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 TOWNE PARK DR W STE 103",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313269098",
            "telephone_number": "912-826-0918",
            "fax_number": "912-826-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANTHAM",
        "first_name": "ANISA",
        "middle_name": "D",
        "credential": "LPC, NCAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2015-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "004189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James R Gill, M.D.
• Kristal Gill, PMHNP-BC
• Janneska Godoy
• Amber Ivey Gordon, DMD
• Charles Edward Grant Jr., ATC
• David B Greenfield, M.D.
• Tiffany J Griffin, LCSW
• Jennifer Stephanie Grosse, P.T., D.P.T.,
• Danielle Marie Haggerty, M.A., CCC-SLP
• Katie Rose Hagin

• Professional Counselor in Rincon, GA
• Providers in Rincon, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.