Healthcare Provider Details

I. General information

NPI: 1124905237
Provider Name (Legal Business Name): GROUNDWORK PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 N RAVENSWOOD AVE STE 101
CHICAGO IL
60640-7565
US

IV. Provider business mailing address

4611 N RAVENSWOOD AVE STE 101
CHICAGO IL
60640-7565
US

V. Phone/Fax

Practice location:
  • Phone: 872-240-4935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMIE ALBRIGHT
Title or Position: OWNER
Credential: PHD
Phone: 704-620-3099