Provider Demographics
NPI:1821157645
Name:GRIMSHAW-CLARK, MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GRIMSHAW-CLARK
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 1:1 OLD OYSTER POINT RD STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7149
Mailing Address - Country:US
Mailing Address - Phone:757-969-6848
Mailing Address - Fax:757-969-6849
Practice Address - Street 1:1 OLD OYSTER POINT RD STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7149
Practice Address - Country:US
Practice Address - Phone:757-969-6848
Practice Address - Fax:757-969-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ162001041C0700X
VA09040142501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical