DR. JACK HOLLAND GRISHAM (NPI# 1376692061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376692061 |
| Entity Type | Individual |
| Full Name | DR. JACK HOLLAND GRISHAM |
| Credential | PH.D. |
| Practice Address |
122 Cherry St Ne Marietta GA 30060-7206 |
| Practice Telephone | 7704272911 |
| Practice Fax Number | 7704222302 |
| Mailing Telephone | 7704272911 |
| Mailing Fax Number | 7704222302 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 000669 | GA | Behavioral Health & Social Service Providers |
| Street Address |
122 CHERRY ST NE |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-7206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780614636 | Susan Z. Volentine | Psychologist | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2006-07-04 |
| 1407197908 | Townsend Psychology | Psychologist | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2013-03-07 |
| 1558516336 | Edwin W. Nash Jr. | Counselor | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2008-11-20 |
| 1376728394 | Psychological Affiliates | Social Worker | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2008-01-09 |
| 1386845923 | Jill Allweiss | Social Worker | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2007-05-30 |
| 1194851253 | Margaret Ann Brown | Counselor | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2007-02-25 |
| 1093869174 | Daniel Thomas Rogers | Psychologist | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2007-01-23 |
| 1245380716 | Judith 'dee' Cobb | Social Worker | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2007-01-10 |
| 1245396217 | Jodi Ellen Forman | Social Worker | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2006-12-27 |
| 1225190796 | Imogene Hays Brodsky | Social Worker | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2006-12-14 |
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| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356848485 | Valerie Parker, Psy.d., Inc. | Psychologist | 1744 Roswell Rd Ste 200, Marietta, GA 30062-3979 | 2018-04-05 |
| 1750831301 | Quaneecia Rainey | Psychologist | 55 Whitcher St Ne Ste 400, Marietta, GA 30060-1129 | 2016-10-06 |
| 1760727762 | Christy Jaffe | Psychologist | 459 Old Canton Rd, Marietta, GA 30068-3267 | 2012-12-02 |
| 1700111721 | Dongwook Lee | Psychologist | 3939 Roswell Rd Ste 200, Marietta, GA 30062 | 2009-10-08 |
| 1326250978 | Beverly Dawn Brooks | Psychologist | 660 Village Trce Ne Bldg 18, Paper Mill Village Office Park, Marietta, GA 30067-4081 | 2007-05-04 |
| 1023134244 | Cheryl Anderson Williams | Psychologist | 2625 Sandy Plains Rd, Suite 104, Marietta, GA 30066-4260 | 2007-03-21 |
| 1275613481 | Sheryl K. White | Psychologist | 416 1/2 Colegate Dr, Marietta, OH 45750-9549 | 2006-10-16 |
| 1003822073 | Jeffrey John Pipe | Psychologist | 127 Church St Ne, Suite 350, Marietta, GA 30060-8637 | 2006-07-31 |
| 1780617159 | Marc Isralsky, PC | Psychologist | 840 Church St Ne, Bldg. F, Marietta, GA 30060-8936 | 2006-07-09 |
| 1780614636 | Susan Z. Volentine | Psychologist | 122 Cherry St Ne, Marietta, GA 30060-7206 | 2006-07-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.