Healthcare Provider Details

I. General information

NPI: 1174235238
Provider Name (Legal Business Name): SHINING OAK WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 ROUND COVE RD
CHATHAM MA
02633-1247
US

IV. Provider business mailing address

284 ROUND COVE RD
CHATHAM MA
02633-1247
US

V. Phone/Fax

Practice location:
  • Phone: 617-398-7080
  • Fax:
Mailing address:
  • Phone: 617-398-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. GRANT PIKE
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 617-398-7080