Provider Demographics
NPI:1508943614
Name:GRIMES, KATHERYN PERRINE (MA)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:PERRINE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 SIXTH AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2421
Mailing Address - Country:US
Mailing Address - Phone:304-523-1142
Mailing Address - Fax:304-523-2966
Practice Address - Street 1:1415 SIXTH AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2421
Practice Address - Country:US
Practice Address - Phone:304-523-1142
Practice Address - Fax:304-523-2966
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV761101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor