Provider Demographics
NPI:1699911032
Name:GRANDIS EVALUATION CENTER, P.C.
Entity type:Organization
Organization Name:GRANDIS EVALUATION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:828-299-7451
Mailing Address - Street 1:1011 TUNNEL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2058
Mailing Address - Country:US
Mailing Address - Phone:828-299-7451
Mailing Address - Fax:828-299-7454
Practice Address - Street 1:1011 TUNNEL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2058
Practice Address - Country:US
Practice Address - Phone:828-299-7451
Practice Address - Fax:828-299-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty