=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205472834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOING TO GROUND COUNSELING AND CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2019
-----------------------------------------------------
Last Update Date | 12/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 LORI RD STE 101
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-6758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-621-4034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8905 HUNTINGCREEK TER
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23237-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-234-3359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ASHLEY RENEE MELTON
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 804-234-3359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------