Healthcare Provider Details

I. General information

NPI: 1750872776
Provider Name (Legal Business Name): ZINA NIA GRACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 FAYETTEVILLE RD SE
ATLANTA GA
30316-2932
US

IV. Provider business mailing address

5496 S HYDE PARK BLVD APT 508
CHICAGO IL
60615-5863
US

V. Phone/Fax

Practice location:
  • Phone: 404-486-9034
  • Fax:
Mailing address:
  • Phone: 872-300-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: