Provider Demographics
NPI:1194989897
Name:GROETSCH, NELLENE MARIE (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:NELLENE
Middle Name:MARIE
Last Name:GROETSCH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:NC
Mailing Address - Zip Code:27920-1251
Mailing Address - Country:US
Mailing Address - Phone:252-561-5315
Mailing Address - Fax:
Practice Address - Street 1:50840 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:NC
Practice Address - Zip Code:27936
Practice Address - Country:US
Practice Address - Phone:252-561-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health