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General NPI Number Information
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NPI Number | 1356903231
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Entity Type | Individual
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Provider Name | MARY LESLIE GROVES ROSSI BC-DMT
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 3419 VALLE VERDE DR # 707
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City | NAPA
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State | CA
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Zip | 94558-2414
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Country | US
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Telephone | 707-299-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 420 GILLCREST AVE
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City | VALLEJO
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State | CA
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Zip | 94591-8009
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Country | US
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Telephone | 707-655-3420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APCC7459
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT117176
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License Number State | CA
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