Healthcare Provider Details

I. General information

NPI: 1851097257
Provider Name (Legal Business Name): ROBERT GRIMES LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WICKER ST
SANFORD NC
27330-4151
US

IV. Provider business mailing address

29 LONGLEAF PINE WAY
SANFORD NC
27332-2544
US

V. Phone/Fax

Practice location:
  • Phone: 919-292-2614
  • Fax: 919-964-3374
Mailing address:
  • Phone: 951-392-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022612
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: