Individual
MR. JEREMIAH GROGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
601 N BELAIR SQ STE 2, EVANS, GA 30809-0518
(706) 836-1195
(844) 873-4758
Mailing address
601 N BELAIR SQ STE 2, EVANS, GA 30809
(706) 836-1195
(844) 873-4758
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC009114
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003181469A
—
GA
Enumeration date
08/11/2016
Last updated
07/21/2022
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