Provider Demographics
NPI:1730849746
Name:GRIMES, SHAMEKA SHONETTE
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:SHONETTE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
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 575
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NC
Mailing Address - Zip Code:27806-0575
Mailing Address - Country:US
Mailing Address - Phone:252-501-3771
Mailing Address - Fax:
Practice Address - Street 1:1425 S GLENBURNIE RD STE 2
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-336-3646
Practice Address - Fax:252-421-9200
Is Sole Proprietor?:No
Enumeration Date:2021-12-19
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27563101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)