Provider Demographics
NPI:1528517950
Name:ROSEN-GRANDON, JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:ROSEN-GRANDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1054
Mailing Address - Country:US
Mailing Address - Phone:336-292-2116
Mailing Address - Fax:336-292-2162
Practice Address - Street 1:3106 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1054
Practice Address - Country:US
Practice Address - Phone:336-292-2116
Practice Address - Fax:336-292-2162
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS2299101YP2500X
NC423 LMFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional