Provider Demographics
NPI:1699382556
Name:JASON L GRINER LCSW PC
Entity Type:Organization
Organization Name:JASON L GRINER LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LA RON
Authorized Official - Last Name:GRINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:229-251-0264
Mailing Address - Street 1:1267 ROUNTREE BRIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:GA
Mailing Address - Zip Code:31647-6423
Mailing Address - Country:US
Mailing Address - Phone:229-251-0264
Mailing Address - Fax:
Practice Address - Street 1:2914 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1718
Practice Address - Country:US
Practice Address - Phone:229-333-0300
Practice Address - Fax:229-333-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty