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Organization
YOUTH VILLAGES
Active
Organization
YOUTH VILLAGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTEN JON GROSS (FAMILY COUNSELOR)
(216) 403-4177
Entity
Organization
Contact information
Practice address
2428 CHARLES BLVD, GREENVILLE, NC 27858-5924
(252) 215-5708
Mailing address
2428 CHARLES BLVD, GREENVILLE, NC 27858-5924
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
S. 0030847
OH
Other
Enumeration date
07/08/2009
Last updated
08/08/2009
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