Provider Demographics
NPI:1386356202
Name:GRIMES, ALVONETTE KOLOA (HEALTH EDUCATOR SPEC)
Entity type:Individual
Prefix:MISS
First Name:ALVONETTE
Middle Name:KOLOA
Last Name:GRIMES
Suffix:
Gender:F
Credentials:HEALTH EDUCATOR SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 52ND ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5512
Mailing Address - Country:US
Mailing Address - Phone:202-277-3389
Mailing Address - Fax:
Practice Address - Street 1:839 52ND ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5512
Practice Address - Country:US
Practice Address - Phone:202-277-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171400000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator