Provider Demographics
NPI:1396040762
Name:GRINDSTAFF, JEMMA PRICE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEMMA
Middle Name:PRICE
Last Name:GRINDSTAFF
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 1:9220 FAIRBANKS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1405
Mailing Address - Country:US
Mailing Address - Phone:919-896-8214
Mailing Address - Fax:
Practice Address - Street 1:9220 FAIRBANKS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1405
Practice Address - Country:US
Practice Address - Phone:919-896-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3273103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001290 MPNMedicaid