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General NPI Number Information
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NPI Number | 1548079700
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Entity Type | Organization
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Legal Business Name | THE GROUNDED MIND THERAPY AND CONSULTATION, L.L.C.
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1817 GREEN CIR
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City | VALDOSTA
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State | GA
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Zip | 31602-2885
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Country | US
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Telephone | 229-244-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 GREEN CIR
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City | VALDOSTA
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State | GA
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Zip | 31602-2885
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. CHASTIDY BOUTIN
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Credential | LCSW
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Telephone | 706-341-2745
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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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