Provider Demographics
NPI:1760939615
Name:THE GROVES COUNSELING CENTER
Entity Type:Organization
Organization Name:THE GROVES COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCS
Authorized Official - Phone:704-913-2327
Mailing Address - Street 1:2005 FLINT LN
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3334
Mailing Address - Country:US
Mailing Address - Phone:980-522-8247
Mailing Address - Fax:704-865-8008
Practice Address - Street 1:2005 FLINT LN
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3334
Practice Address - Country:US
Practice Address - Phone:980-522-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC4742S251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty