Provider Demographics
NPI:1437932480
Name:GRACEFULLY CONNECTED, LLC
Entity Type:Organization
Organization Name:GRACEFULLY CONNECTED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMEIKA
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-535-5057
Mailing Address - Street 1:4400 MCCAAN QUAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4260
Mailing Address - Country:US
Mailing Address - Phone:757-535-5214
Mailing Address - Fax:
Practice Address - Street 1:4400 MCCAAN QUAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4260
Practice Address - Country:US
Practice Address - Phone:757-535-5214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health