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General NPI Number Information
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NPI Number | 1821364258
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Entity Type | Individual
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Provider Name | DARA M GRIMES
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 2960 CHAIN BRIDGE RD STE 200
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City | OAKTON
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State | VA
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Zip | 22124-3040
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Country | US
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Telephone | 703-490-0336
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Fax |
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Provider Business Mailing Address
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Address Line | 158 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-4063
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Country | US
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Telephone | 219-663-0888
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000970A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34006575A
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License Number State | IN
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