Provider Demographics
NPI:1356466643
Name:GRIM, DEANNA R (LPC)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:R
Last Name:GRIM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:R
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:320 MAXWELL RD
Mailing Address - Street 2:SUITE 600 C
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2070
Mailing Address - Country:US
Mailing Address - Phone:678-300-4746
Mailing Address - Fax:
Practice Address - Street 1:320 MAXWELL RD
Practice Address - Street 2:SUITE 600 C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2070
Practice Address - Country:US
Practice Address - Phone:678-300-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA099972183AMedicaid