Provider Demographics
NPI:1972765113
Name:GROVE, DAVID R (LISW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:GROVE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 EASTWIND DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3360
Mailing Address - Country:US
Mailing Address - Phone:614-882-3684
Mailing Address - Fax:
Practice Address - Street 1:1001 EASTWIND DR STE 201
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3360
Practice Address - Country:US
Practice Address - Phone:614-882-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI36791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical