Healthcare Provider Details

I. General information

NPI: 1770419624
Provider Name (Legal Business Name): GROUNDED PLACE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 FISHER DR
CUMBERLAND MD
21502-6372
US

IV. Provider business mailing address

1230 NATIONAL HWY # 1001
LAVALE MD
21502-7612
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-8696
  • Fax:
Mailing address:
  • Phone: 240-413-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RENEE MONIQUE DAVIS
Title or Position: OWNER
Credential: LPC, LCPC, PSYD
Phone: 240-413-8696