Provider Demographics
NPI:1578134219
Name:GRISSETT, KIMBERLY GRACE (RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GRACE
Last Name:GRISSETT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 ROSS CLARK CIR STE 5
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4916
Mailing Address - Country:US
Mailing Address - Phone:334-477-4686
Mailing Address - Fax:334-443-0294
Practice Address - Street 1:2543 ROSS CLARK CIR STE 5
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-699-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-04
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician