Healthcare Provider Details

I. General information

NPI: 1700735156
Provider Name (Legal Business Name): BADASS GRANDMA VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SEVEN OAKS DR
CLAYTON NC
27520-8034
US

IV. Provider business mailing address

9 SEVEN OAKS DR
CLAYTON NC
27520-8034
US

V. Phone/Fax

Practice location:
  • Phone: 919-606-9376
  • Fax:
Mailing address:
  • Phone: 919-606-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA JOYCE SCARLET WALTERS
Title or Position: CEO
Credential: CERTIFIED COACH
Phone: 919-606-9376