Individual
DIANNE GROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1522 HIGHWAY 330, BOGART, GA 30622-2908
(404) 295-3561
Mailing address
1522 HIGHWAY 330, BOGART, GA 30622-2908
(404) 295-3561
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002262
GA
Other
Enumeration date
01/21/2020
Last updated
01/21/2020
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