MEDICARE: CAILLA GRIZZLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC008199	GA

General Provider Information

NPI Number	:	1134882160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAILLA GRIZZLE

Provider Business Mailing Address
First Line	:	145 HOWARD LN
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-1848
Country	:	US
Telephone Number	:	706-616-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 HOWARD LN
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-1848
Country	:	US
Telephone Number	:	706-616-7172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2021
Last Update Date	:	06/19/2024

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Directions to “ CAILLA GRIZZLE ” Practice Location

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