Provider Demographics
NPI:1376069880
Name:GOOD GROUNDS LLC
Entity Type:Organization
Organization Name:GOOD GROUNDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARQUITA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:804-888-2039
Mailing Address - Street 1:17285 PERINCHIEF ST
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-5807
Mailing Address - Country:US
Mailing Address - Phone:804-728-7649
Mailing Address - Fax:
Practice Address - Street 1:3076 HULL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-3574
Practice Address - Country:US
Practice Address - Phone:804-888-2039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty