Provider Demographics
NPI:1710265145
Name:GRIMES, CORNELIUS CLAYBORNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:CLAYBORNE
Last Name:GRIMES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 ARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3810
Mailing Address - Country:US
Mailing Address - Phone:404-840-0640
Mailing Address - Fax:
Practice Address - Street 1:920 DANNON VW SW
Practice Address - Street 2:SUITE 3104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2157
Practice Address - Country:US
Practice Address - Phone:404-840-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0040681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical