Provider Demographics
NPI:1184791873
Name:GRIMMETT, MARC ANDERSON (PHD, HSP-P)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANDERSON
Last Name:GRIMMETT
Suffix:
Gender:M
Credentials:PHD, HSP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 KNIGHTSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8440
Mailing Address - Country:US
Mailing Address - Phone:919-622-3504
Mailing Address - Fax:919-515-6891
Practice Address - Street 1:3801 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2934
Practice Address - Country:US
Practice Address - Phone:919-784-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3145103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling