Provider Demographics
NPI:1144182783
Name:GRIMES, AHARON J'AIVAHN
Entity type:Individual
Prefix:
First Name:AHARON
Middle Name:J'AIVAHN
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ACE
Other - Middle Name:J'AIVAHN
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1320 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5941
Mailing Address - Country:US
Mailing Address - Phone:714-780-1174
Mailing Address - Fax:714-844-9153
Practice Address - Street 1:1320 W PEARL ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5941
Practice Address - Country:US
Practice Address - Phone:714-780-1174
Practice Address - Fax:714-844-9153
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-02
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23951101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)