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General NPI Number Information
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NPI Number | 1033091442
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Entity Type | Organization
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Legal Business Name | SACRED GROUND THERAPY
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 9308 SUN BLUFF WAY APT 303
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-7919
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Country | US
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Telephone | 434-327-9285
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Fax |
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Provider Business Mailing Address
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Address Line | 9308 SUN BLUFF WAY APT 303
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-7919
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Country | US
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Telephone | 434-327-9285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QOURTASIA KESHONE WATSON
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Credential | LCSW
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Telephone | 434-327-9285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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