Provider Demographics
NPI:1396070389
Name:GRIMM, NICOLE ELENA (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELENA
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MCCOLLUM ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1532
Mailing Address - Country:US
Mailing Address - Phone:864-710-0391
Mailing Address - Fax:
Practice Address - Street 1:100 MCCOLLUM ST STE 2
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1532
Practice Address - Country:US
Practice Address - Phone:864-710-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6599101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor