Provider Demographics
NPI:1558028381
Name:GRIMES, LAKENDRA (LICSW)
Entity Type:Individual
Prefix:
First Name:LAKENDRA
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 20TH ST N STE 157
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3601
Mailing Address - Country:US
Mailing Address - Phone:314-662-3650
Mailing Address - Fax:
Practice Address - Street 1:400 OFFICE PARK DR STE 308
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-3411
Practice Address - Country:US
Practice Address - Phone:205-975-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty