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Individual
MR. JESSE GRONBACK
Active
Individual
MR. JESSE GRONBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW, PMHNP
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C007267
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5017230
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3410049
—
NC
Enumeration date
04/30/2010
Last updated
03/01/2023
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