MEDICARE: INNER GRACE COUNSELING AND WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811741606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER GRACE COUNSELING AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	1010 NUTT ST APT 2237
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-5395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 PINER RD STE A634
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4201
Country	:	US
Telephone Number	:	910-367-5340
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW BELL
Credential	:	LCMHCA
Telephone Number	:	910-367-5340

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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