Provider Demographics
NPI:1043049307
Name:GROVES, GENE JR
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:
Last Name:GROVES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 BAIKAL LOOP
Mailing Address - Street 2:HOUSE
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:202-255-2675
Mailing Address - Fax:
Practice Address - Street 1:7050 CHESAPEAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2345
Practice Address - Country:US
Practice Address - Phone:240-770-7204
Practice Address - Fax:866-635-2959
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health