Healthcare Provider Details

I. General information

NPI: 1013669332
Provider Name (Legal Business Name): GRIT CITY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S 7TH ST
TACOMA WA
98405-2506
US

IV. Provider business mailing address

3121 S 7TH ST
TACOMA WA
98405-2506
US

V. Phone/Fax

Practice location:
  • Phone: 253-302-4639
  • Fax:
Mailing address:
  • Phone: 253-302-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY PICO
Title or Position: DIRECTOR
Credential: LICSW
Phone: 253-302-4639