MEDICARE: MATTHEW GROTSKY LCMHC, LCASA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-26133	NC
2	101YM0800X	Mental Health Counselor	A15357	NC
3	101YP2500X	Professional Counselor	A15357	NC
4	101YP2500X	Professional Counselor	15357	NC

General Provider Information

NPI Number	:	1881239440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GROTSKY LCMHC, LCASA

Provider Business Mailing Address
First Line	:	6135 PARK SOUTH DR SUITE 510
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210
Country	:	US
Telephone Number	:	828-606-9129
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E CHESTNUT ST STE 4
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2480
Country	:	US
Telephone Number	:	828-400-6299
Fax Number	:	828-484-4912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	01/16/2023

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