Provider Demographics
NPI:1427929678
Name:GROTHEER, JUSTIN RUDOLPH (LCMFT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RUDOLPH
Last Name:GROTHEER
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1209
Mailing Address - Country:US
Mailing Address - Phone:913-213-3309
Mailing Address - Fax:
Practice Address - Street 1:219 N KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1209
Practice Address - Country:US
Practice Address - Phone:913-213-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist