Healthcare Provider Details

I. General information

NPI: 1194531129
Provider Name (Legal Business Name): GROWTH & GRACE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SUNRISE AVE STE 212
LEXINGTON NC
27292-4309
US

IV. Provider business mailing address

21 SUNRISE AVE STE 212
LEXINGTON NC
27292-4309
US

V. Phone/Fax

Practice location:
  • Phone: 704-762-1464
  • Fax:
Mailing address:
  • Phone: 704-762-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHEL WILLERT BRAZIL
Title or Position: MEMBER/ORGZANIZER
Credential: LCSW, LCAS-A
Phone: 704-762-1464