Provider Demographics
NPI:1346057486
Name:GRONAU, JEREMY MICHAEL (MA, GCCA)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:GRONAU
Suffix:
Gender:M
Credentials:MA, GCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CRESTBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8934
Mailing Address - Country:US
Mailing Address - Phone:770-580-9610
Mailing Address - Fax:
Practice Address - Street 1:705 CRESTBROOK CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8934
Practice Address - Country:US
Practice Address - Phone:770-580-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11245338101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral