Provider Demographics
NPI:1780619296
Name:ROSEN GRANDON ASSOCIATES, INC
Entity type:Organization
Organization Name:ROSEN GRANDON ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSEN-GRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-292-2116
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC2299101Y00000X
NCMFT423106H00000X
FLMT0000258106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC72721OtherBCBS