Provider Demographics
NPI:1104965649
Name:GROUX, CAROLE (LPC)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:GROUX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BEARDS DOCK XING
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1307
Mailing Address - Country:US
Mailing Address - Phone:480-335-7216
Mailing Address - Fax:
Practice Address - Street 1:1410 FOREST DR STE 31
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1446
Practice Address - Country:US
Practice Address - Phone:443-214-8414
Practice Address - Fax:443-767-4396
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10772101YM0800X
NC4998101YM0800X
MDLC5836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102907Medicaid
NC141H4OtherBLUE CROSS BLUE SHIELD
NC184540OtherMEDCOST PROVIDER NUMBER