Provider Demographics
NPI:1144987900
Name:GRATEFUL JOURNEY LLC
Entity type:Organization
Organization Name:GRATEFUL JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-314-6107
Mailing Address - Street 1:3768 SOUTHWAY DR SW APT 88
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2247
Mailing Address - Country:US
Mailing Address - Phone:540-314-6107
Mailing Address - Fax:
Practice Address - Street 1:4220 CYPRESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8403
Practice Address - Country:US
Practice Address - Phone:540-772-1872
Practice Address - Fax:540-772-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty