Healthcare Provider Details

I. General information

NPI: 1194580530
Provider Name (Legal Business Name): FLINT GRIMES CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 MALOY DR
MC DOWELL VA
24458-2200
US

IV. Provider business mailing address

PO BOX 109
MC DOWELL VA
24458-0109
US

V. Phone/Fax

Practice location:
  • Phone: 757-647-6638
  • Fax:
Mailing address:
  • Phone: 757-647-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACY LYNN GRIMES
Title or Position: OFFICER
Credential: LCSW
Phone: 757-647-6638