Provider Demographics
NPI:1841213154
Name:GROSSENS, TAMARA J (MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:GROSSENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3449
Mailing Address - Country:US
Mailing Address - Phone:828-433-9190
Mailing Address - Fax:828-433-9130
Practice Address - Street 1:205 E UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3449
Practice Address - Country:US
Practice Address - Phone:828-433-9190
Practice Address - Fax:828-433-9130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081644104100000X
NCC0064581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M37760013Medicare PIN