Provider Demographics
NPI:1689327215
Name:GROWING FORWARD LLC
Entity Type:Organization
Organization Name:GROWING FORWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DENEE
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:540-762-3520
Mailing Address - Street 1:1432 DENNISON AVE.
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-1729
Mailing Address - Country:US
Mailing Address - Phone:540-762-3520
Mailing Address - Fax:
Practice Address - Street 1:1432 DENNISON AVE.
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-1729
Practice Address - Country:US
Practice Address - Phone:540-762-3520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROWING FORWARD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty