Healthcare Provider Details

I. General information

NPI: 1316006802
Provider Name (Legal Business Name): SUSAN C GRIGG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S MAIN ST
PLYMOUTH MI
48170-2253
US

IV. Provider business mailing address

710 HEMPHILL ST
YPSILANTI MI
48198-3022
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-3440
  • Fax: 734-451-8720
Mailing address:
  • Phone: 734-395-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL693907
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: