Provider Demographics
NPI:1093593527
Name:GRUBB, DENISE MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:GRUBB
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HAMPTON POINT DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3119
Mailing Address - Country:US
Mailing Address - Phone:904-829-2273
Mailing Address - Fax:904-824-0724
Practice Address - Street 1:175 HAMPTON POINT DR STE 2
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3119
Practice Address - Country:US
Practice Address - Phone:904-829-2273
Practice Address - Fax:904-824-0724
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health