Healthcare Provider Details

I. General information

NPI: 1508522632
Provider Name (Legal Business Name): STAYGROUNDEED HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 RUSSELL PKWY STE C9
WARNER ROBINS GA
31088-8697
US

IV. Provider business mailing address

2101 BROADWAY AVE
GADSDEN AL
35904-4715
US

V. Phone/Fax

Practice location:
  • Phone: 205-615-1445
  • Fax:
Mailing address:
  • Phone: 205-615-1445
  • Fax: 205-558-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHARDONNEY LA'SHAI WASHINGTON
Title or Position: MENTAL HEALTH COUNSELOR/OWNER
Credential: LPC, NCC, CRC
Phone: 205-615-1445