Provider Demographics
NPI:1184930042
Name:GRISWOLD, BRIAN E (MS, NCC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:GRISWOLD
Suffix:
Gender:M
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WICKERSHAM WAY
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3315
Mailing Address - Country:US
Mailing Address - Phone:410-236-7555
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-236-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral