Individual
JENNIFER GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
356 CHARLOTTE RD, RUTHERFORDTON, NC 28139
(941) 441-8068
Mailing address
356 CHARLOTTE RD, RUTHERFORDTON, NC 28139-2916
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21245
NC
101YP2500X
Professional Counselor
A11241
NC
224Z00000X
Occupational Therapy Assistant
OTA 10151
FL
Other
Enumeration date
08/13/2007
Last updated
05/21/2019
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