Provider Demographics
NPI:1427844513
Name:GRISSETT, EBONEE TAYLOR
Entity type:Individual
Prefix:
First Name:EBONEE
Middle Name:TAYLOR
Last Name:GRISSETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 GIBRALTAR ROCK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-8826
Mailing Address - Country:US
Mailing Address - Phone:919-309-5689
Mailing Address - Fax:
Practice Address - Street 1:1601 JONES FRANKLIN RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3379
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20155A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist