Provider Demographics
NPI:1376068528
Name:GRACE COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:GRACE COUNSELING AND WELLNESS
Other - Org Name:GRACE COUNSELING AND WELLNESS, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATION
Authorized Official - Middle Name:
Authorized Official - Last Name:KONCHELLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-494-5743
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27342-0122
Mailing Address - Country:US
Mailing Address - Phone:336-494-5743
Mailing Address - Fax:
Practice Address - Street 1:2224 LACY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5341
Practice Address - Country:US
Practice Address - Phone:336-494-5743
Practice Address - Fax:866-278-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty