Provider Demographics
NPI:1215045190
Name:GROCE, ANGELA MARIA (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIA
Last Name:GROCE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:MCEACHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:210 CHESTNUT WREN RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016
Mailing Address - Country:US
Mailing Address - Phone:803-606-3685
Mailing Address - Fax:803-705-5690
Practice Address - Street 1:1620 PENDLETON ST A207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3836
Practice Address - Country:US
Practice Address - Phone:803-705-5156
Practice Address - Fax:803-705-5690
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical