Provider Demographics
NPI:1356219448
Name:MCLAURIN, GRACE REBECCA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:REBECCA
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6862 ELM ST STE 820
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3868
Mailing Address - Country:US
Mailing Address - Phone:703-677-8243
Mailing Address - Fax:
Practice Address - Street 1:6862 ELM ST STE 820
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3868
Practice Address - Country:US
Practice Address - Phone:703-677-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701015545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health