Individual
CHARLES E GROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, MSW
Contact information
Practice address
1900 S ISEMINGER ST, PHILADELPHIA, PA 19148-2207
(267) 847-4148
Mailing address
809 LOCUST ST, MAZZONI CENTER FAMILY & COMMUNITY MEDICINE, PHILADELPHIA, PA 19107-5507
(215) 563-0658
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
SW 131589
PA
Other
Enumeration date
09/10/2012
Last updated
01/02/2017
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