Provider Demographics
NPI:1548307879
Name:GRIGG, CAROLE AUGUST (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:AUGUST
Last Name:GRIGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AUGUST
Other - Middle Name:C
Other - Last Name:GRIGG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:138 SOUTH FIRST STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3623
Mailing Address - Country:US
Mailing Address - Phone:360-249-5266
Mailing Address - Fax:360-249-5266
Practice Address - Street 1:138 SOUTH FIRST STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3623
Practice Address - Country:US
Practice Address - Phone:360-249-5266
Practice Address - Fax:360-249-5266
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000062681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA93422281400003OtherPREMERA BLUE CROSS NATION
WAQMXPR0055747OtherMOLINAHEALTH CARE
WA228140228139OtherPREMERA BLUE CROSS
PIN0007434031OtherAETNA
WA8910383OtherDEPT OF LABOR & INDUSTRIE