Provider Demographics
NPI:1497401319
Name:ASPEN GROVE WELLNESS
Entity Type:Organization
Organization Name:ASPEN GROVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-800-8696
Mailing Address - Street 1:201 PROSPECT AVE # 122
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3204
Mailing Address - Country:US
Mailing Address - Phone:301-800-8696
Mailing Address - Fax:
Practice Address - Street 1:201 PROSPECT AVE STE 159
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3204
Practice Address - Country:US
Practice Address - Phone:301-800-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty