Provider Demographics
NPI:1013525666
Name:GRIM, SAMANTHA JO
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JO
Last Name:GRIM
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1055 E COLORADO BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2380
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:5951 DUGOUT TER
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4570
Practice Address - Country:US
Practice Address - Phone:800-299-5230
Practice Address - Fax:855-224-4326
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician