Provider Demographics
NPI:1285668038
Name:GROFF, MARY E (MSW LCSW ACSW PIP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:GROFF
Suffix:
Gender:F
Credentials:MSW LCSW ACSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 OLD TOWN ST
Mailing Address - Street 2:MOUNTAIN CREST COUNSELING
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976
Mailing Address - Country:US
Mailing Address - Phone:256-582-0300
Mailing Address - Fax:256-582-0335
Practice Address - Street 1:414 OLD TOWN ST
Practice Address - Street 2:MOUNTAIN CREST COUNSELING
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-582-0300
Practice Address - Fax:256-582-0335
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL212PIP0026C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51090464OtherBCBC
6291841OtherUBH
98226Medicare UPIN