Provider Demographics
NPI:1225781974
Name:ANCORA WELLNESS LLC
Entity Type:Organization
Organization Name:ANCORA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:570-499-0674
Mailing Address - Street 1:96 S ANGELL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5328
Mailing Address - Country:US
Mailing Address - Phone:570-499-0674
Mailing Address - Fax:
Practice Address - Street 1:96 S ANGELL ST APT 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5328
Practice Address - Country:US
Practice Address - Phone:401-647-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCORA WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty