Grissom, Jackie M.
Grissom, Jackie M. is an sole proprietor health care provider with primary practice located at 1238 Mann Dr Matthews Family Counseling, Matthews NC 28105-1061. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Grissom, Jackie M. can be contacted via phone (704) 771-1714.Contact Information
Primary practice address
1238 Mann Dr Matthews Family Counseling
Matthews NC 28105-1061
Phone: (704) 771-1714
Fax: (704) 771-1890
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2798 | North Carolina |
Profile Details
| NPI number | 1215917117 |
|---|---|
| LBN Legal business name | Grissom, Jackie M. |
| Credentials | M.A., L.P.C. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 18th, 2006 |
| Last updated | Jul 6th, 2010 - about 15 years ago |
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 | 1215917117 | NPPES |
| North Carolina | MEDICAID | 6102673 |
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