| Doctor Name: | MS. JACQUELINE DALE GRANTLAND |
| NPI Number: | 1316905524 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, NCC |
| License Number: | 5199 |
| Business Practice Address: | 21945 Three Notch Rd Ste 103 Lexington Park, MD - 206531563 |
| Business Phone Number: | 3018638460 |
| Business Fax Number: | 2407181906 |
| Mailing Address: | Po Box 1662, LEXINGTON PARK |
| State: | MD |
| Postal Code: | 206531662 |
| Phone Number: | 3018638460 |
| Fax Number: | 2407181906 |
| NPI Enumeration Date: | 05/04/2006 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 5199 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |