Individual
MARYAM MARDANBIGI GRIMWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
112 W CENTER ST, FAYETTEVILLE, AR 72701-6073
(479) 316-7770
Mailing address
2314 E POLK DR, FAYETTEVILLE, AR 72703-4991
(479) 601-1004
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
A1109095
AR
101YM0800X
Mental Health Counselor
Primary
P1804043
AR
170300000X
Genetic Counselor (M.S.)
—
—
Other
Enumeration date
06/10/2006
Last updated
02/06/2019
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