MEDICARE: GROVE COUNSELING

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780873059	OTHER		NPI

General Provider Information

NPI Number	:	1649833229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVE COUNSELING

Provider Business Mailing Address
First Line	:	6813 FAIRVIEW RD STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3364
Country	:	US
Telephone Number	:	347-377-2733
Fax Number	:	704-909-4009

Provider Business Practice Location Address
First Line	:	6813 FAIRVIEW RD STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3364
Country	:	US
Telephone Number	:	347-377-2733
Fax Number	:	704-909-4009

Authorized Official
Title or Position	:	OWNER
Name	:	BREEANNA TERESA FALESCHINI
Credential	:	LCSW
Telephone Number	:	612-508-9403

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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Directions to “GROVE COUNSELING ” Practice Location

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