Healthcare Provider Details

I. General information

NPI: 1457500969
Provider Name (Legal Business Name): JENNIFER CHRISTY GRINNELL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 DALLAS AVE
SILVER SPRING MD
20901-2028
US

IV. Provider business mailing address

5301 76TH AVE
LANDOVER HILLS MD
20784-1703
US

V. Phone/Fax

Practice location:
  • Phone: 301-844-8242
  • Fax:
Mailing address:
  • Phone: 301-459-2121
  • Fax: 301-459-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC1551
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: