Provider Demographics
NPI:1336731496
Name:GRIMSLEY, DANIEL FRANKLIN (LGSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FRANKLIN
Last Name:GRIMSLEY
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 FERNWOOD DR UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2460
Mailing Address - Country:US
Mailing Address - Phone:334-441-6129
Mailing Address - Fax:
Practice Address - Street 1:1628 FERNWOOD DR UPPR MARLBORO
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2460
Practice Address - Country:US
Practice Address - Phone:334-441-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker