Active NPI
Grant Charles Kirkwood, CDCA
- Peer Specialist
- Andover, OH
National Provider Identifier
1639610595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 000120
- Practice address
- 158 W Main St
Andover, OH 44003-9318 - Phone
- (216) 353-4723
- NPI assigned
- Mar 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 165555 | OH | |
| Behavior Technician | 106S00000X | OH | ||
| Peer Specialist | 175T00000X | 000120 | OH | Primary |
Addresses
Primary practice location
158 W Main St
Andover, OH 44003-9318
Mailing address
158 W Main St
Andover, OH 44003-9318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 165555 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| 000120 | OH | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733356800000",
"number": "1639610595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "158 W MAIN ST",
"city": "ANDOVER",
"state": "OH",
"postal_code": "440039318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 W MAIN ST",
"city": "ANDOVER",
"state": "OH",
"postal_code": "440039318",
"telephone_number": "216-353-4723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRKWOOD",
"first_name": "GRANT",
"middle_name": "CHARLES",
"credential": "CDCA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-13",
"last_updated": "2024-12-05",
"certification_date": "2024-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "165555",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "OH",
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "000120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.