Healthcare Provider Details

I. General information

NPI: 1790452928
Provider Name (Legal Business Name): CRYSTAL WASHINGTON GRICE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MAJOR FRED CT
JAMESTOWN NC
27282-8471
US

IV. Provider business mailing address

1633 NEW GARDEN RD # 2007
GREENSBORO NC
27410-2001
US

V. Phone/Fax

Practice location:
  • Phone: 336-223-4624
  • Fax:
Mailing address:
  • Phone: 336-223-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA16766
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: