Healthcare Provider Details

I. General information

NPI: 1023789039
Provider Name (Legal Business Name): KELLY GRIMES- ACOSTA LGMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY GRIMES

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 BEARDS HILL RD STE 101
ABERDEEN MD
21001-2295
US

IV. Provider business mailing address

1013 BEARDS HILL ROAD SUITE 101; PMB 138
ABERDEEN MD
21001
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-5040
  • Fax:
Mailing address:
  • Phone: 443-440-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: