Individual
DARA M GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2960 CHAIN BRIDGE RD STE 200, OAKTON, VA 22124-3040
(703) 490-0336
Mailing address
158 N MAIN ST, CROWN POINT, IN 46307-4063
(219) 663-0888
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000970A
IN
1041C0700X
Clinical Social Worker
Primary
34006575A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200275200A
—
IN
Enumeration date
03/29/2012
Last updated
01/06/2020
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