Provider Demographics
NPI:1538474606
Name:HIPONA, GRACE GINA (MS, NCC, ACS, LPC)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:GINA
Last Name:HIPONA
Suffix:
Gender:F
Credentials:MS, NCC, ACS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 RAVENEL LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2429
Mailing Address - Country:US
Mailing Address - Phone:404-849-6516
Mailing Address - Fax:
Practice Address - Street 1:12584 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2485
Practice Address - Country:US
Practice Address - Phone:866-528-3385
Practice Address - Fax:703-499-9889
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004097171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor