Provider Demographics
NPI:1093372427
Name:GROOVER, GENEVIEVE CAROL (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:CAROL
Last Name:GROOVER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:ODEN
Mailing Address - State:MI
Mailing Address - Zip Code:49764-0213
Mailing Address - Country:US
Mailing Address - Phone:231-373-0306
Mailing Address - Fax:
Practice Address - Street 1:2594 SPRINGVALE RD
Practice Address - Street 2:
Practice Address - City:BOYNE FALLS
Practice Address - State:MI
Practice Address - Zip Code:49713-9684
Practice Address - Country:US
Practice Address - Phone:231-535-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103168104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker