Provider Demographics
NPI:1821800863
Name:GRIGSBY, MADIA T (MA LADC)
Entity type:Individual
Prefix:
First Name:MADIA
Middle Name:T
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:MA LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 S 8TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-4501
Mailing Address - Country:US
Mailing Address - Phone:612-261-8138
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELARD PKWY STE 325
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6453
Practice Address - Country:US
Practice Address - Phone:763-522-0100
Practice Address - Fax:763-588-0100
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)