Provider Demographics
NPI:1679019954
Name:GRIMES, SANDRA EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:EILEEN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 TAYLOR DRAPER LN STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3971
Mailing Address - Country:US
Mailing Address - Phone:812-964-9666
Mailing Address - Fax:
Practice Address - Street 1:11211 TAYLOR DRAPER LN STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3971
Practice Address - Country:US
Practice Address - Phone:512-964-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical