Doctor Name: | LETICIA FREELAND GROVE |
NPI Number: | 1063647618 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LMHC |
License Number: | MH9752 |
Business Practice Address: | 16500 Panama City Beach Pkwy Suite A Panama City Beach, FL - 324132251 |
Business Phone Number: | 8502911344 |
Business Fax Number: | 8502505759 |
Mailing Address: | 19974 Front Beach Rd, PANAMA CITY BEACH |
State: | FL |
Postal Code: | 324134431 |
Phone Number: | 8502911344 |
Fax Number: | 8502505759 |
NPI Enumeration Date: | 05/27/2009 |
NPI Last Update Date: | 04/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH9752 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |