Healthcare Provider Details

I. General information

NPI: 1093226664
Provider Name (Legal Business Name): ALYSSA GRIGGS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 E VIRGINIA ST
EVANSVILLE IN
47715-2611
US

IV. Provider business mailing address

4847 E VIRGINIA ST
EVANSVILLE IN
47715-2611
US

V. Phone/Fax

Practice location:
  • Phone: 866-755-4258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number33008305A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: