Provider Demographics
NPI:1891291753
Name:GRISSETT, DARIAN SR
Entity Type:Individual
Prefix:MR
First Name:DARIAN
Middle Name:
Last Name:GRISSETT
Suffix:SR
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 1:1565 BAHAMA ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5401
Mailing Address - Country:US
Mailing Address - Phone:386-898-1594
Mailing Address - Fax:
Practice Address - Street 1:1565 BAHAMA ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5401
Practice Address - Country:US
Practice Address - Phone:386-898-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker