Provider Demographics
NPI:1457500969
Name:GRINNELL, JENNIFER CHRISTY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTY
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1703
Mailing Address - Country:US
Mailing Address - Phone:301-459-2121
Mailing Address - Fax:301-459-0675
Practice Address - Street 1:10107 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2028
Practice Address - Country:US
Practice Address - Phone:301-844-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1551101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health