=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689516528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GROUND AND GROW WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2026
-----------------------------------------------------
Last Update Date | 04/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44075 PIPELINE PLZ STE 225
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-5889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-267-0737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 SHILOH PL SE
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20175-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-267-0737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | NIKKI R GREAUX
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 571-267-0737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------