Provider Demographics
NPI:1821068719
Name:GRISWOLD, MARILEE CHANTAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILEE
Middle Name:CHANTAL
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 FARROW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3220
Mailing Address - Country:US
Mailing Address - Phone:803-521-2503
Mailing Address - Fax:
Practice Address - Street 1:7901 FARROW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3220
Practice Address - Country:US
Practice Address - Phone:803-521-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC215322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215324Medicaid
SC215324Medicaid