Provider Demographics
NPI:1386509164
Name:GRISWOLD INTEGRATIVE PSYCHIATRY, LLC
Entity type:Organization
Organization Name:GRISWOLD INTEGRATIVE PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:626-733-3250
Mailing Address - Street 1:119 THE PLAINS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20117-2691
Mailing Address - Country:US
Mailing Address - Phone:626-733-3250
Mailing Address - Fax:
Practice Address - Street 1:119 THE PLAINS RD STE 300
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20117-2691
Practice Address - Country:US
Practice Address - Phone:626-733-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-23
Last Update Date:2025-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty