Provider Demographics
NPI:1225810930
Name:GRIMSLEY, KERRI OWENS
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:OWENS
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3924
Mailing Address - Country:US
Mailing Address - Phone:833-432-5285
Mailing Address - Fax:833-432-5329
Practice Address - Street 1:1125 PENNY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3924
Practice Address - Country:US
Practice Address - Phone:833-432-5285
Practice Address - Fax:833-432-5329
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty