Individual
MADISON GROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3754 LAVISTA RD, TUCKER, GA 30084-5626
(678) 983-4199
Mailing address
2810 ELDERBERRY LN, CUMMING, GA 30040-7181
(678) 983-4199
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC015835
GA
Other
Enumeration date
02/11/2026
Last updated
02/11/2026
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