Provider Demographics
NPI:1730209032
Name:GRANDSTAFF, DANIEL G (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:GRANDSTAFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2019
Mailing Address - Country:US
Mailing Address - Phone:919-968-2122
Mailing Address - Fax:
Practice Address - Street 1:725 KENMORE RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2019
Practice Address - Country:US
Practice Address - Phone:919-968-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0021641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical