Marisa Ann Grimmius, MA, LCMHCA, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A19569 Issued in NC

Practice address

111 Kilson Dr Ste 201
Mooresville, NC 28117-8218

Phone

(704) 664-1009

NPI assigned

Jan 12, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Miracles Healing Centers Inc

  • Mental Health Counselor
  • Mooresville, NC
  • NPI 1962597732
  NPD
• Wellcomemd NC Clinic PLLC

  • Internal Medicine Physician
  • Mooresville, NC
  • NPI 1013525278
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1083485528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15115 OXFORD HOLW",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785511",
            "telephone_number": "910-528-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 KILSON DR STE 201",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178218",
            "telephone_number": "704-664-1009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5641 Poplar Tent Rd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280277588",
            "country_code": "US",
            "telephone_number": "704-664-1009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIMMIUS",
        "first_name": "MARISA",
        "middle_name": "ANN",
        "credential": "MA, LCMHCA, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A19569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA BOARD OF CLINICAL MENTAL HEALTH COUNSELORS",
            "identifier": "A19569",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Nicole Gregory
• Taryn Ann Greiner, CCC-SLP
• Laura L. Grier, DDS
• Lauren Grier
• Shadese Lisa Griffith-McClellan, LCSW-A,MSW
• Sarah Groff, LPC
• Andrew Francis Leigh Gross, M.D.
• Nicole Gross
• Stefanie Elizabeth Gross, D.C
• Thomas Emil Gross, M.D.

• Mental Health Counselor in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.