Healthcare Provider Details

I. General information

NPI: 1942126941
Provider Name (Legal Business Name): GRACED FOR THE JOURNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

IV. Provider business mailing address

PO BOX 34
BRANDYWINE MD
20613-0034
US

V. Phone/Fax

Practice location:
  • Phone: 301-375-0548
  • Fax:
Mailing address:
  • Phone:
  • 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: ELEANA STEWART
Title or Position: SOCIAL WORKER, CLINICAL
Credential: LCSW-C
Phone: 301-375-0548