Healthcare Provider Details

I. General information

NPI: 1174317754
Provider Name (Legal Business Name): GROUNDED STARS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 AMSTERDAM AVENUE
NEW YORK NY
10031
US

IV. Provider business mailing address

535 FIFTH AVENUE, 4TH FLOOR #1021
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 914-294-4639
  • Fax: 917-277-7178
Mailing address:
  • Phone: 914-294-4639
  • Fax: 917-277-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MS. KIERRA ELSIE WATSON
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential: MHA
Phone: 803-280-6982