Healthcare Provider Details

I. General information

NPI: 1518736883
Provider Name (Legal Business Name): GROWING GRACEFULLY COUNSELING AND CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 UNION ST S # 1034
CONCORD NC
28025-5009
US

IV. Provider business mailing address

57 UNION ST S # 1034
CONCORD NC
28025-5009
US

V. Phone/Fax

Practice location:
  • Phone: 980-285-2993
  • Fax:
Mailing address:
  • Phone: 980-285-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALEEA SUTTON
Title or Position: OWNER
Credential:
Phone: 980-285-2993