Provider Demographics
NPI:1699920595
Name:GRANVILLE COUNSELING CENTER LLC
Entity type:Organization
Organization Name:GRANVILLE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEG
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:740-587-1720
Mailing Address - Street 1:935 RIVER RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9584
Mailing Address - Country:US
Mailing Address - Phone:740-587-1720
Mailing Address - Fax:740-587-1721
Practice Address - Street 1:935 RIVER RD
Practice Address - Street 2:SUITE I
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9584
Practice Address - Country:US
Practice Address - Phone:740-587-1720
Practice Address - Fax:740-587-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00052151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty