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General NPI Number Information
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NPI Number | 1164842761
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Entity Type | Organization
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Legal Business Name | GROUNDWORK COUNSELING LLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 400 S ORLANDO AVE SUITE 206
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City | MAITLAND
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State | FL
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Zip | 32751-5644
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Country | US
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Telephone | 407-378-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S ORLANDO AVE SUITE 206
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City | MAITLAND
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State | FL
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Zip | 32751-5644
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Country | US
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Telephone | 407-378-3000
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | COURTNEY RODRIGUE
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Credential |
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Telephone | 407-378-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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