Provider Demographics
NPI:1326553017
Name:GRINDSTAFF, DEBRA VIOLETT (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:VIOLETT
Last Name:GRINDSTAFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 DOUGLAS AVE STE 2040
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2004
Mailing Address - Country:US
Mailing Address - Phone:610-241-5114
Mailing Address - Fax:407-710-1524
Practice Address - Street 1:1110 DOUGLAS AVE STE 2040
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2004
Practice Address - Country:US
Practice Address - Phone:407-378-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW177321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty