Provider Demographics
NPI:1528561842
Name:ORLESA GROSVENOR
Entity Type:Organization
Organization Name:ORLESA GROSVENOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORLESA
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:352-208-4497
Mailing Address - Street 1:350 G ST SW
Mailing Address - Street 2:N620
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3129
Mailing Address - Country:US
Mailing Address - Phone:352-208-4497
Mailing Address - Fax:
Practice Address - Street 1:350 G ST SW
Practice Address - Street 2:N620
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3129
Practice Address - Country:US
Practice Address - Phone:352-208-4497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50081368251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health