Individual provider Active NPI

Mary Robin Grove, CRC, LPC

  • Professional Counselor
  • Canton, GA
National Provider Identifier
1043648694
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC005065 Issued in GA
Practice address
310 Paper Trail Way
106
Canton, GA 30115-5203
Phone
(678) 880-4645
NPI assigned
Oct 17, 2013
Last updated
Oct 17, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC005065 GA Primary

Addresses

Primary practice location

310 Paper Trail Way
106
Canton, GA 30115-5203

Mailing address

310 Paper Trail Way
106
Canton, GA 30115-5203
Phone (678) 880-4645

Other identifiers 1

IdentifierTypeStateIssuer
45-5480838MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240909000455 GA Practitioner - Mental Health Counselor 3375083108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Canton Counseling LLCGroup PAC ID 9830639749, 6 clinicians

Practice addresses (Care Compare)

310 Paper Trail Way
Suite 106
Canton, GA 30115-0000
Phone (678) 880-4645

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC005065GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Canton Counseling, LLC Professional CurrentSince Jul 17, 2024 Accepting new patients

Locations

310 Paper Trail Way
Ste 106
Holly Springs, GA 30115
Phone (678) 880-4645

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1043648694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 PAPER TRAIL WAY",
            "address_2": "106",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301155203",
            "telephone_number": "678-880-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 PAPER TRAIL WAY",
            "address_2": "106",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301155203",
            "telephone_number": "678-880-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVE",
        "first_name": "MARY",
        "middle_name": "ROBIN",
        "credential": "CRC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-17",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC005065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45-5480838",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.