Provider Demographics
NPI:1801673629
Name:THE GROWTH COLLECTIVE LLC
Entity type:Organization
Organization Name:THE GROWTH COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-349-5133
Mailing Address - Street 1:440 MONTICELLO AVE SUITE 1802
Mailing Address - Street 2:PMB 67255
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2052
Mailing Address - Country:US
Mailing Address - Phone:703-483-1520
Mailing Address - Fax:
Practice Address - Street 1:5250 CHEROKEE AVE STE 305
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2052
Practice Address - Country:US
Practice Address - Phone:703-763-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty