Provider Demographics
NPI:1952773111
Name:GROVES, KRISTINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:GROVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:IN
Mailing Address - Zip Code:47610-0384
Mailing Address - Country:US
Mailing Address - Phone:812-319-6438
Mailing Address - Fax:812-482-6409
Practice Address - Street 1:325 W TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:IN
Practice Address - Zip Code:47610-9152
Practice Address - Country:US
Practice Address - Phone:812-319-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99068576A104100000X
IN34008133A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker