Healthcare Provider Details

I. General information

NPI: 1306219340
Provider Name (Legal Business Name): ALEXANDER GRIGG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WALL ST SUITE F
CINCINNATI OH
45212-2781
US

IV. Provider business mailing address

446 MORGAN ST
CINCINNATI OH
45206-2348
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-429-4939
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.1700485
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1700485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: