Healthcare Provider Details

I. General information

NPI: 1376410084
Provider Name (Legal Business Name): EBONY GRACE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 PHILLIP MORRIS DR STE 204B
SALISBURY MD
21804-2000
US

IV. Provider business mailing address

6456 OXBRIDGE DR
SALISBURY MD
21801-1793
US

V. Phone/Fax

Practice location:
  • Phone: 410-200-0953
  • Fax:
Mailing address:
  • Phone: 410-200-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINEKA CHANTEY HARMON
Title or Position: OWNER/OPERATOR
Credential: LCSW-C
Phone: 301-524-3617