Provider Demographics
NPI:1366515439
Name:GRISWOLD, ANNA S (PHD)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:S
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 KAWANA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2030
Mailing Address - Country:US
Mailing Address - Phone:803-252-4935
Mailing Address - Fax:803-252-7658
Practice Address - Street 1:1620 LADY ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3404
Practice Address - Country:US
Practice Address - Phone:803-252-4935
Practice Address - Fax:803-252-7658
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2672Medicare ID - Type Unspecified