Provider Demographics
NPI:1326629452
Name:GROVES, WAYNE LEROY
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:LEROY
Last Name:GROVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KENDALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3456
Mailing Address - Country:US
Mailing Address - Phone:248-797-0008
Mailing Address - Fax:
Practice Address - Street 1:28212 KENDALLWOOD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3456
Practice Address - Country:US
Practice Address - Phone:248-797-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional