Provider Demographics
NPI:1669096509
Name:GRIMSTED, ALINA (LCSW)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:GRIMSTED
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:MCLEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1949 SE PALMQUIST RD UNIT 47
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-6283
Mailing Address - Country:US
Mailing Address - Phone:503-804-7549
Mailing Address - Fax:503-715-4943
Practice Address - Street 1:19265 SE STARK ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5758
Practice Address - Country:US
Practice Address - Phone:503-755-8988
Practice Address - Fax:503-715-4943
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORL117861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program