Provider Demographics
NPI:1083419436
Name:ALLISON, GRANT (CADC II)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:ALLISON
Suffix:
Gender:
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 AUTUMN CRK
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1557
Mailing Address - Country:US
Mailing Address - Phone:770-301-4622
Mailing Address - Fax:
Practice Address - Street 1:105 AUTUMN CRK
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-1557
Practice Address - Country:US
Practice Address - Phone:770-301-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)