Basic Information
| Provider Information | |||||||||
| NPI: | 1760145890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROVE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | NEW SEASONS TREATMENT CENTER | ||||||||
| Address2: | 16110 EVERLY RD | ||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017140837 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NEW SEASONS TREATMENT CENTER | ||||||||
| Address2: | 16110 EVERLY RD | ||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017140837 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2021 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCA2834 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.