Healthcare Provider Details

I. General information

NPI: 1235277633
Provider Name (Legal Business Name): ANGELINA CHARLES GRINDON LCSW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823 CYPRESSWOOD DR INTERFACE SAMARITAN COUNSELING CENTER
SPRING TX
77379
US

IV. Provider business mailing address

6823 CYPRESSWOOD DR INTERFACE SAMARITAN COUNSELING CENTER
SPRING TX
77379
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-8006
  • Fax: 713-376-8008
Mailing address:
  • Phone: 281-376-8006
  • Fax: 713-376-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3803
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ8839
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: