Healthcare Provider Details

I. General information

NPI: 1902671274
Provider Name (Legal Business Name): ALLYCIA GRIEBNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINWA BLVD
ANDERSON SC
29621-4486
US

IV. Provider business mailing address

127 W OLD PENDLETON RD
CENTRAL SC
29630-9769
US

V. Phone/Fax

Practice location:
  • Phone: 864-260-2220
  • Fax:
Mailing address:
  • Phone: 864-633-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12643
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: