Provider Demographics
NPI:1235277633
Name:GRINDON, ANGELINA CHARLES (LCSW LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:CHARLES
Last Name:GRINDON
Suffix:
Gender:F
Credentials:LCSW LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 CYPRESSWOOD DR
Mailing Address - Street 2:INTERFACE SAMARITAN COUNSELING CENTER
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:281-376-8006
Mailing Address - Fax:713-376-8008
Practice Address - Street 1:6823 CYPRESSWOOD DR
Practice Address - Street 2:INTERFACE SAMARITAN COUNSELING CENTER
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:281-376-8006
Practice Address - Fax:713-376-8008
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3803101YP2500X
TXQ88391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00515QMedicare ID - Type Unspecified