Provider Demographics
NPI:1285487470
Name:GRASSY CREEK COUNSELING, LLC
Entity type:Organization
Organization Name:GRASSY CREEK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAILA-LEIGH
Authorized Official - Middle Name:TESTERMAN
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-914-7246
Mailing Address - Street 1:1315 CRANESBILL CT APT 302
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-2430
Mailing Address - Country:US
Mailing Address - Phone:443-502-0406
Mailing Address - Fax:
Practice Address - Street 1:1306 LIRIOPE CT APT T3
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-2648
Practice Address - Country:US
Practice Address - Phone:410-914-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health