Provider Demographics
NPI:1992460836
Name:KIDD-GRIJIALIVA, SATISHA DE-ANNA (LMSW)
Entity type:Individual
Prefix:
First Name:SATISHA
Middle Name:DE-ANNA
Last Name:KIDD-GRIJIALIVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SARA JANE PKWY APT 127
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8601
Mailing Address - Country:US
Mailing Address - Phone:469-684-6517
Mailing Address - Fax:
Practice Address - Street 1:1525 US HIGHWAY 380 STE 500183
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0174
Practice Address - Country:US
Practice Address - Phone:469-684-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62164104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker