Provider Demographics
NPI:1710797436
Name:GROVE, RYAN (LCSWA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GROVE
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 HOPE VALLEY RD STE 4F-209
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5651
Mailing Address - Country:US
Mailing Address - Phone:919-627-7367
Mailing Address - Fax:
Practice Address - Street 1:3819 S COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-6617
Practice Address - Country:US
Practice Address - Phone:919-627-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP021593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health