Healthcare Provider Details

I. General information

NPI: 1841126810
Provider Name (Legal Business Name): CASSIDY GRILES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 OLD BUCKINGHAM RD
POWHATAN VA
23139-5757
US

IV. Provider business mailing address

1442 JUNCTION CANAL RD
CHARLOTTE COURT HOUSE VA
23923-2910
US

V. Phone/Fax

Practice location:
  • Phone: 804-598-2200
  • Fax:
Mailing address:
  • Phone: 434-208-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: