Provider Demographics
NPI:1427716844
Name:GRANDY, LAURA (MSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GRANDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 JOHN MILTON DR STE 210
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2564
Mailing Address - Country:US
Mailing Address - Phone:703-214-4925
Mailing Address - Fax:703-214-4925
Practice Address - Street 1:2579 JOHN MILTON DR STE 210
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2564
Practice Address - Country:US
Practice Address - Phone:703-214-4925
Practice Address - Fax:703-214-4925
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060097231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical