Provider Demographics
NPI:1225082456
Name:GROBAN, KAREN J (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:GROBAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 HILLCREST RD NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1710
Mailing Address - Country:US
Mailing Address - Phone:770-564-0590
Mailing Address - Fax:770-564-8565
Practice Address - Street 1:630 HILLCREST RD NW
Practice Address - Street 2:SUITE 400
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1710
Practice Address - Country:US
Practice Address - Phone:770-564-0590
Practice Address - Fax:770-564-8565
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW001664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00882791AMedicaid
GA80BBFLSMedicare ID - Type Unspecified
GA00882791AMedicaid