Healthcare Provider Details

I. General information

NPI: 1366137168
Provider Name (Legal Business Name): GRACE AND MERCY COMMUNITY SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 PRESIDENTS DRIVE SUITE 232
LANHAM MD
20706
US

IV. Provider business mailing address

4601 PRESIDENTS DRIVE SUITE 232
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 202-853-8109
  • Fax: 301-441-2360
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MERCY FORLU
Title or Position: DIRECTOR
Credential:
Phone: 202-359-9725