Provider Demographics
NPI:1649764366
Name:GRIGSBY, KELLY L (LPC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHRISTOPHERS WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-6121
Mailing Address - Country:US
Mailing Address - Phone:706-615-1691
Mailing Address - Fax:
Practice Address - Street 1:1605 VERNON RD STE 1500
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4166
Practice Address - Country:US
Practice Address - Phone:706-615-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty