Provider Demographics
NPI:1659314045
Name:GROTSKY, HOWARD S (EDD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:S
Last Name:GROTSKY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 RANDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2829
Mailing Address - Country:US
Mailing Address - Phone:910-791-5719
Mailing Address - Fax:910-799-8180
Practice Address - Street 1:5010 RANDALL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2829
Practice Address - Country:US
Practice Address - Phone:910-791-5719
Practice Address - Fax:910-799-8180
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51751OtherCIGNA BEHAVIORAL HEALTH #
NC6000123Medicaid
NC192530000OtherMAGELLEN PROVIDER NUMBER
NCA314799OtherVALUE OPTIONS GROUP #
NC12748OtherPARNTERS NATIONAL HEALTH
NC03655OtherBLUE CROSS BLUE SHIELD #
NC51751OtherCIGNA PROVIDER NUMBER
NC066683OtherVALUE OPTIONS PROVIDER #
NC4279018OtherAETNA PROVIDER NUMBER
NCB5436OtherMEDCOST PROVIDER NUMBER
NCA314799OtherVALUE OPTIONS GROUP #