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General NPI Number Information
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NPI Number | 1962916817
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Entity Type | Individual
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Provider Name | SHANA NICOLE GRIMES LGSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 325 STAFFORD RD
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City | BARSTOW
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State | MD
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Zip | 20610-2061
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Country | US
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Telephone | 410-535-4300
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Fax | 410-535-3079
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Provider Business Mailing Address
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Address Line | 920 JUDGE CT E
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City | WEST RIVER
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State | MD
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Zip | 20778-2001
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Country | US
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Telephone | 512-788-3232
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23403
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License Number State | MD
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