Grantland, Jacqueline Dale
Grantland, Jacqueline Dale is an sole proprietor health care provider with primary practice located at 22776 Three Notch Rd Ste 210 , Lexington Park MD 20653-3370. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Grantland, Jacqueline Dale can be contacted via phone (301) 866-6333.Contact Information
Primary practice address
22776 Three Notch Rd Ste 210
Lexington Park MD 20653-3370
Phone: (301) 866-6333
Fax: (240) 718-1906
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 5199 | North Carolina |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | LC4189 | Maryland |
Profile Details
| NPI number | 1316905524 |
|---|---|
| LBN Legal business name | Grantland, Jacqueline Dale |
| Credentials | LCPC, NCC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 4th, 2006 |
| Last updated | Aug 13th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316905524 | NPPES |
| North Carolina | MEDICAID | 6103219 | |
| North Carolina | MEDICAID | 058356100 |
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