Provider Demographics
NPI:1700929940
Name:AFFILIATED SANTE GROUP DBA CRISYS
Entity Type:Organization
Organization Name:AFFILIATED SANTE GROUP DBA CRISYS
Other - Org Name:CRISYS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGSBY-HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CPRP
Authorized Official - Phone:301-572-6358
Mailing Address - Street 1:810 TYVOLA RD. STE. 126
Mailing Address - Street 2:
Mailing Address - City:CHARLOTEE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3536
Mailing Address - Country:US
Mailing Address - Phone:704-566-3410
Mailing Address - Fax:301-572-5062
Practice Address - Street 1:810 TYVOLA RD. STE. 126
Practice Address - Street 2:
Practice Address - City:CHARLOTEE
Practice Address - State:NC
Practice Address - Zip Code:28217-3536
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:301-572-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301491Medicaid