MEDICARE: MR. CASEY DURWOOD GROOVER LPCA

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	101YP2500X	Professional Counselor	A10400	NC

General Provider Information

NPI Number	:	1023445707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CASEY DURWOOD GROOVER LPCA

Provider Business Mailing Address
First Line	:	901 ARSENAL AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5398
Country	:	US
Telephone Number	:	910-323-3368
Fax Number	:	910-486-7000

Provider Business Practice Location Address
First Line	:	901 ARSENAL AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5398
Country	:	US
Telephone Number	:	910-323-3368
Fax Number	:	910-486-7000

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

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	09/27/2013

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