Individual
MR. JACK SILER GRIMES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
15 DAVIS ST, PORTSMOUTH, VA 23702-3021
(757) 238-2038
(757) 238-2038
Mailing address
9016 RIVER CRES, SUFFOLK, VA 23433-1304
(757) 238-2038
(757) 238-2038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904000386
VA
Other
Enumeration date
12/07/2006
Last updated
07/09/2007
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