Provider Demographics
NPI:1881311892
Name:CHAN, GRACE H (LPC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:H
Last Name:CHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 RESTON PKWY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3388
Mailing Address - Country:US
Mailing Address - Phone:703-592-6797
Mailing Address - Fax:
Practice Address - Street 1:1760 RESTON PKWY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3388
Practice Address - Country:US
Practice Address - Phone:703-592-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor