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MS. JACKIE M. GRISSOM LCMHC
NPI 1215917117
Counselor - Professional in Kannapolis, NC

Active since January 18, 2006Opted out of Medicare · through Sep 1, 2026
6001 GATEWAY CENTER DR., SUITE 105, KANNAPOLIS, NC 28081(704) 905-5201(704) 612-7043 Get Directions Write a Review

NPPES record last updated: February 26, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Jackie M. Grissom Lcmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. JACKIE M. GRISSOM LCMHC (NPI 1215917117) is an individual professional provider in Kannapolis, North Carolina, licensed in North Carolina (2798) and active in the NPI registry since January 2006. She has opted out of Medicare through September 1, 2026.

NPPES Registry Identity

NPI1215917117
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameMS. JACKIE M. GRISSOMCredential: LCMHC
Location Address6001 GATEWAY CENTER DR., SUITE 105Kannapolis, NC 28081
Mailing Address905 Calle CalmadoLas Cruces, NM 88007 · (704) 905-5201 · Fax (704) 612-7043
Phone(704) 905-5201
Fax(704) 612-7043
Sole ProprietorYes
Enumeration DateJanuary 18, 2006
Last NPPES UpdateFebruary 26, 2025
✔ NPI 1215917117 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in NC · 2798
6001 GATEWAY CENTER DR., Kannapolis, NC 28081
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Other Names 1

Other Name (5)Jacqualyn M. Grissom

Other Identifiers 1

Medicaid6102673NC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Ms. Jackie M. Grissom Lcmhc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 1, 2024 through September 1, 2026.

Opt-Out Effective DateSeptember 1, 2024
Opt-Out In Effect ThroughSeptember 1, 2026Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Grissom's NPI number?

The NPI number for Jackie Grissom is 1215917117. It was assigned to this individual provider in the NPPES registry on January 18, 2006. The provider is also known as Jacqualyn M. Grissom.

Where is Jackie Grissom located?

Jackie Grissom practices at 6001 Gateway Center Dr. Suite 105, Kannapolis, NC 28081. The listed phone number is (704) 905-5201.

What is Jackie Grissom's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Jackie Grissom enrolled in Medicare?

No. Jackie Grissom has opted out of Medicare through September 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Jackie Grissom accept?

Health plans from Blue Cross and Blue Shield of NC list Jackie Grissom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jackie Grissom was last updated on February 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.