Provider Demographics
NPI:1699869594
Name:GRISHAM, SANDRA J (LPCC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:GRISHAM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1402
Mailing Address - Country:US
Mailing Address - Phone:330-531-3591
Mailing Address - Fax:330-758-5121
Practice Address - Street 1:105 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-1402
Practice Address - Country:US
Practice Address - Phone:330-531-5391
Practice Address - Fax:330-758-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2641101YP2500X
101YP2500X
OHSZ1118104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker