Provider Demographics
NPI:1528267622
Name:GRIM, SARA ELIZABETH (MRC CRC LICDC PCC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELIZABETH
Last Name:GRIM
Suffix:
Gender:F
Credentials:MRC CRC LICDC PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-0029
Mailing Address - Country:US
Mailing Address - Phone:419-352-5387
Mailing Address - Fax:419-352-5439
Practice Address - Street 1:320 W GYPSY LANE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4572
Practice Address - Country:US
Practice Address - Phone:419-352-5387
Practice Address - Fax:419-352-5439
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00051709101Y00000X
OH021255101YA0400X
OHE0007946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)