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General NPI Number Information
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NPI Number | 1588232375
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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 | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 2987 YARMOUTH GREENWAY DR STE 207
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City | FITCHBURG
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State | WI
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Zip | 53711-5852
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Country | US
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Telephone | 608-286-1556
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Fax | 608-218-3796
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Provider Business Mailing Address
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Address Line | 2987 YARMOUTH GREENWAY DR STE 207
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City | FITCHBURG
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State | WI
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Zip | 53711-5852
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Country | US
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Telephone | 608-286-1556
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Fax | 608-218-3796
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Authorized Official
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Title or Position | FOUNDER AND THERAPIST
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Name | HADEEL SUFIAN HASAN
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Credential | LCSW, CSAC
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Telephone | 608-286-1556
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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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