Individual
MR. RICHARD GRIMES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5213 BURBANK ST, COLUMBUS, GA 31907-4018
(706) 566-1479
Mailing address
5213 BURBANK ST, COLUMBUS, GA 31907-4018
(706) 566-1479
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2209
—
GA
Enumeration date
07/03/2015
Last updated
07/03/2015
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