Individual
JENNIFER L GROOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
Mailing address
6136 W RIVER RD S, ELYRIA, OH 44035-5432
(440) 258-8452
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.175731
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCII.161781
OH
Other
Enumeration date
04/01/2021
Last updated
05/03/2022
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