Provider Demographics
NPI:1154905248
Name:GROVE, MAEGHAN (ACIT 1)
Entity type:Individual
Prefix:
First Name:MAEGHAN
Middle Name:
Last Name:GROVE
Suffix:
Gender:F
Credentials:ACIT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-5078
Mailing Address - Country:US
Mailing Address - Phone:765-480-9187
Mailing Address - Fax:
Practice Address - Street 1:1759 HOGAN DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5078
Practice Address - Country:US
Practice Address - Phone:765-480-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INT-5101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)