Provider Demographics
NPI:1568116044
Name:GRIMES, JAMELL HAKIM
Entity Type:Individual
Prefix:
First Name:JAMELL
Middle Name:HAKIM
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29200 NORTHWESTERN HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1055
Mailing Address - Country:US
Mailing Address - Phone:248-756-8766
Mailing Address - Fax:
Practice Address - Street 1:29200 NORTHWESTERN HWY STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1055
Practice Address - Country:US
Practice Address - Phone:248-756-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852091994104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker