Individual
JENNIFER STUART GRISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5320 BRIDGERS RD STE 4, SHALLOTTE, NC 28470-4737
(910) 769-9126
Mailing address
6472 ROLLING RUN RD, SOUTHPORT, NC 28461-8302
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704013796
VA
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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