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General NPI Number Information
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NPI Number | 1700735156
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Entity Type | Organization
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Legal Business Name | BADASS GRANDMA VENTURES LLC
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 03/01/2026
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Provider Practice Location Address
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Address Line | 9 SEVEN OAKS DR
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City | CLAYTON
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State | NC
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Zip | 27520-8034
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Country | US
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Telephone | 919-606-9376
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Fax |
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Provider Business Mailing Address
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Address Line | 9 SEVEN OAKS DR
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City | CLAYTON
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State | NC
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Zip | 27520-8034
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Country | US
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Telephone | 919-606-9376
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CYNTHIA JOYCE SCARLET WALTERS
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Credential | CERTIFIED COACH
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Telephone | 919-606-9376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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