# MR. JESSE GRONBACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1487971412
- **Gender:** Man
- **Credential:** MSW, LCSW, PMHNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | C007267 | NC | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 5017230 | NC | Yes |

## Other

- **Enumeration date:** 04/30/2010
- **Last updated:** 03/01/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3410049 | — | NC |