Provider Demographics
NPI:1790228336
Name:GRIGSBY, HENRY I
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:GRIGSBY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42109 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2371
Mailing Address - Country:US
Mailing Address - Phone:313-461-4789
Mailing Address - Fax:
Practice Address - Street 1:42109 SALEM CT
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2371
Practice Address - Country:US
Practice Address - Phone:313-461-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker