Healthcare Provider Details

I. General information

NPI: 1356118400
Provider Name (Legal Business Name): GROW OR GO THERAPY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 E PERRY ST STE 900
PORT CLINTON OH
43452-1586
US

IV. Provider business mailing address

1854 E PERRY ST STE 900
PORT CLINTON OH
43452-1586
US

V. Phone/Fax

Practice location:
  • Phone: 419-359-5110
  • Fax: 419-359-5114
Mailing address:
  • Phone: 419-359-5110
  • Fax: 419-359-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA HARRIS
Title or Position: OWNER/THERAPIST
Credential: LISW-S
Phone: 419-573-9163