Individual
MRS. JANET MCCULLOUGH GRIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LMFT PA
Contact information
Practice address
1726 KINGSLEY AVE, SUITE 3, ORANGE PARK, FL 32073
(904) 269-7500
(904) 269-9972
Mailing address
1726 KINGSLEY AVE, SUITE 3, ORANGE PARK, FL 32073
(904) 269-7500
(904) 269-9972
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10732102
CAQH
—
01
—
5971037
AETNA
—
01
—
Z1385
BCBS
—
Enumeration date
11/14/2005
Last updated
07/08/2007
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