Provider Demographics
NPI:1093165391
Name:GRIM, CAROLINE COLUNGA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:COLUNGA
Last Name:GRIM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43145 SUGAR ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6700
Mailing Address - Country:US
Mailing Address - Phone:909-223-8826
Mailing Address - Fax:
Practice Address - Street 1:45111 FERN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2301
Practice Address - Country:US
Practice Address - Phone:661-949-1206
Practice Address - Fax:661-940-5452
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA107146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF80914OtherREGISTRATION NUMBER FOR MARRIAGE FAMILY THERAPIST INTERN
CA107146OtherLINCENSE MARRIAGE FAMILY THERAPIS