Healthcare Provider Details

I. General information

NPI: 1497327357
Provider Name (Legal Business Name): MACIE JOELLEN GROCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 04/02/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HUNTER CT
BOWLING GREEN KY
42103-7032
US

IV. Provider business mailing address

130 HUNTER CT
BOWLING GREEN KY
42103-7032
US

V. Phone/Fax

Practice location:
  • Phone: 270-791-8189
  • Fax:
Mailing address:
  • Phone: 270-459-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259083
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: