Individual
MS. JACKIE M. GRISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
6001 GATEWAY CENTER DR., SUITE 105, KANNAPOLIS, NC 28081
(704) 905-5201
(704) 612-7043
Mailing address
905 CALLE CALMADO, LAS CRUCES, NM 88007
(704) 905-5201
(704) 612-7043
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2798
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6102673
—
NC
Enumeration date
01/18/2006
Last updated
02/26/2025
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