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General NPI Number Information
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NPI Number | 1740914316
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Entity Type | Organization
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Legal Business Name | GROUNDED IN GROWTH LLC
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 416 PLYMOUTH AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505
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Country | US
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Telephone | 586-944-4146
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 LAKE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2860
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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 | PSYCHOLOGIST
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Name | NICOLE MARGANTI
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Credential | PSYD, ABPP
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Telephone | 586-944-4146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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