Provider Demographics
NPI:1861814899
Name:GROCE, CARLA JEAN (LPCC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:GROCE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:GROCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80 ROLLING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9005
Mailing Address - Country:US
Mailing Address - Phone:606-343-0216
Mailing Address - Fax:606-343-0224
Practice Address - Street 1:80 ROLLING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9005
Practice Address - Country:US
Practice Address - Phone:606-343-0216
Practice Address - Fax:606-343-0224
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100868100Medicaid