Individual
JONATHAN MARK GRIZZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
89 HOSPITAL CIR, ELLIJAY, GA 30540-9669
(706) 636-1386
Mailing address
PO BOX 1203, BLUE RIDGE, GA 30513-0021
(706) 633-9319
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
007805
GA
101YP2500X
Professional Counselor
007805
GA
Other
Enumeration date
05/26/2014
Last updated
05/26/2014
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