=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144182783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHARON J'AIVAHN GRIMES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 W PEARL ST
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-780-1174
-----------------------------------------------------
Fax | 714-844-9153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 W PEARL ST
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-780-1174
-----------------------------------------------------
Fax | 714-844-9153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 23951
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------