Provider Demographics
NPI:1982403507
Name:GRANT, ANIKA
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:GRANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SETH PL APT G50
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-7089
Mailing Address - Country:US
Mailing Address - Phone:229-254-5176
Mailing Address - Fax:
Practice Address - Street 1:2415 SETH PL APT G50
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7089
Practice Address - Country:US
Practice Address - Phone:229-254-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool