Provider Demographics
NPI:1033494760
Name:GRIMES, LORI ANN (MAC,LAC,MBA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MAC,LAC,MBA
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAC, LAC, MBA
Mailing Address - Street 1:7937 TRALEE CT
Mailing Address - Street 2:LAUREL
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1158
Mailing Address - Country:US
Mailing Address - Phone:301-257-0414
Mailing Address - Fax:301-776-1499
Practice Address - Street 1:5570 STERRETT PL
Practice Address - Street 2:SUITE 308
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2641
Practice Address - Country:US
Practice Address - Phone:301-257-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist