Provider Demographics
NPI:1215556352
Name:GRANT, ADAM DOUGLAS (CPRC, CPSS, CHW)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DOUGLAS
Last Name:GRANT
Suffix:
Gender:M
Credentials:CPRC, CPSS, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 W MICHIGAN AVE APT L16
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2422
Mailing Address - Country:US
Mailing Address - Phone:517-918-3306
Mailing Address - Fax:
Practice Address - Street 1:124 PEARL ST STE 450
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2663
Practice Address - Country:US
Practice Address - Phone:517-266-8880
Practice Address - Fax:517-266-8881
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30305Medicaid