Healthcare Provider Details

I. General information

NPI: 1912847666
Provider Name (Legal Business Name): GROUNDED WILLOW COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 WARREN ST
CONCORD NH
03301-3837
US

IV. Provider business mailing address

65 HOOKSETT TPKE
CONCORD NH
03301-8402
US

V. Phone/Fax

Practice location:
  • Phone: 603-392-7642
  • Fax: 866-446-3318
Mailing address:
  • Phone: 603-726-1526
  • 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: TINA R OLSON
Title or Position: OWNER
Credential: OLSON
Phone: 603-726-1526