Provider Demographics
NPI:1790142834
Name:GRIMAUD, MARY (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GRIMAUD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-0988
Mailing Address - Country:US
Mailing Address - Phone:256-341-0811
Mailing Address - Fax:256-341-9358
Practice Address - Street 1:475 PROVIDENCE MAIN ST NW STE 401
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4818
Practice Address - Country:US
Practice Address - Phone:256-716-0811
Practice Address - Fax:256-341-5265
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional