Provider Demographics
NPI:1518610179
Name:GRINNELL, SPENCER (LMFT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:GRINNELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PRESTON EXECUTIVE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8433
Mailing Address - Country:US
Mailing Address - Phone:919-467-7777
Mailing Address - Fax:
Practice Address - Street 1:130 PRESTON EXECUTIVE DR STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8433
Practice Address - Country:US
Practice Address - Phone:919-467-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist