Healthcare Provider Details

I. General information

NPI: 1619736477
Provider Name (Legal Business Name): CLAIRE ELLEN GRIESE LPC, NCC, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5519 HAMILTON AVE
COLUMBUS MS
39705-7515
US

IV. Provider business mailing address

5519 HAMILTON AVE
COLUMBUS MS
39705-7515
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 703-595-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3091
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: