Provider Demographics
NPI:1508143512
Name:GRIMES, LATONYA HARRIS (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:HARRIS
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:SIMPSON
Mailing Address - State:NC
Mailing Address - Zip Code:27879-0375
Mailing Address - Country:US
Mailing Address - Phone:252-916-0784
Mailing Address - Fax:252-758-6681
Practice Address - Street 1:642 BROADMOOR CT
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-9188
Practice Address - Country:US
Practice Address - Phone:252-916-0784
Practice Address - Fax:252-758-6681
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0073861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical