MEDICARE: COURTNEY GROVE-DYER MSW, LLMSW

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	6851114121	MI

General Provider Information

NPI Number	:	1710616669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY GROVE-DYER MSW, LLMSW

Provider Business Mailing Address
First Line	:	8264 RACINE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-6746
Country	:	US
Telephone Number	:	313-399-0587
Fax Number	:

Provider Business Practice Location Address
First Line	:	2785 E GRAND BLVD UNIT 611
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-2003
Country	:	US
Telephone Number	:	313-399-0587
Fax Number	:

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/07/2022

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