Healthcare Provider Details

I. General information

NPI: 1952150021
Provider Name (Legal Business Name): PATRICIA GRIGSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 10/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 US 70 HWY E STE 201
GARNER NC
27529-3982
US

IV. Provider business mailing address

1807 TARBERT DR
CARY NC
27511-5037
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-5611
  • Fax: 919-342-8393
Mailing address:
  • Phone: 218-499-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30966
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017286
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: