Healthcare Provider Details

I. General information

NPI: 1780614826
Provider Name (Legal Business Name): THE GROVE COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MAGNOLIA AVE
LONGWOOD FL
32750-4130
US

IV. Provider business mailing address

111 W MAGNOLIA AVE
LONGWOOD FL
32750-4130
US

V. Phone/Fax

Practice location:
  • Phone: 407-327-1765
  • Fax: 407-339-2129
Mailing address:
  • Phone: 407-327-1765
  • Fax: 407-339-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY A BIRCH
Title or Position: PRESIDENT
Credential: LMHC
Phone: 407-327-1765