Provider Demographics
NPI:1558836130
Name:GRIMES, SAMANTHA TINGEN (LPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TINGEN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 GROVE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-2666
Mailing Address - Country:US
Mailing Address - Phone:804-743-0960
Mailing Address - Fax:
Practice Address - Street 1:831 GROVE RD STE C
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-2666
Practice Address - Country:US
Practice Address - Phone:804-743-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor