Healthcare Provider Details

I. General information

NPI: 1366071748
Provider Name (Legal Business Name): SAMETTA GRIGSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5982 BROOKSTONE DR NW
CONCORD NC
28027-2533
US

IV. Provider business mailing address

5982 BROOKSTONE DR NW
CONCORD NC
28027-2533
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-8676
  • Fax:
Mailing address:
  • Phone: 980-785-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: