Provider Demographics
NPI:1720536741
Name:GRIGSBY, MICHELLE ALEXANDRIA (MA, CPRP, LCPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ALEXANDRIA
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:MA, CPRP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10253 PATUXENT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2488
Mailing Address - Country:US
Mailing Address - Phone:240-515-5285
Mailing Address - Fax:
Practice Address - Street 1:9030 STEBBING WAY
Practice Address - Street 2:APT L
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5946
Practice Address - Country:US
Practice Address - Phone:240-294-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health