Individual
JEANETTE GRISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6950 HILLSDALE CT, INDIANAPOLIS, IN 46250-2040
(317) 621-7740
(317) 621-7608
Mailing address
6626 W 75TH STREET, STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000380A
IN
1041C0700X
Clinical Social Worker
Primary
39000273A
IN
Other
Enumeration date
06/30/2015
Last updated
11/09/2020
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