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General NPI Number Information
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NPI Number | 1023632213
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Entity Type | Individual
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Provider Name | BRANDI JO GRIMES QASP-S
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 69 LINDSEY LN STE B
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City | SAINT MARYS
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State | GA
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Zip | 31558-1702
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Country | US
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Telephone | 912-266-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 103 JOHANSEN WAY
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City | KINGSLAND
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State | GA
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Zip | 31548-6857
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-110101
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 11513
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License Number State | GA
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