Individual
DEAETTA GRINNAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
299 COOPER RD STE B, LOGANVILLE, GA 30052-2579
(770) 217-4336
Mailing address
3711 WYNSHIP CT, SNELLVILLE, GA 30039-6799
(302) 423-5754
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC013200
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC013200
PROFESSIONAL COUNSELOR LICENSE
GA
Enumeration date
07/02/2019
Last updated
01/06/2023
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