Provider Demographics
NPI:1013068543
Name:GRIMM, PAMELA VERNELL
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:VERNELL
Last Name:GRIMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 RICHMOND PKWY
Mailing Address - Street 2:#2421
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5207
Mailing Address - Country:US
Mailing Address - Phone:510-222-1378
Mailing Address - Fax:
Practice Address - Street 1:333 VALENCIA ST
Practice Address - Street 2:#222
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3547
Practice Address - Country:US
Practice Address - Phone:415-864-2364
Practice Address - Fax:415-864-0116
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)