Healthcare Provider Details

I. General information

NPI: 1740914316
Provider Name (Legal Business Name): GROUNDED IN GROWTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

1629 LAKE DR SE
GRAND RAPIDS MI
49506-2860
US

V. Phone/Fax

Practice location:
  • Phone: 586-944-4146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MARGANTI
Title or Position: PSYCHOLOGIST
Credential: PSYD, ABPP
Phone: 586-944-4146