Healthcare Provider Details

I. General information

NPI: 1730029125
Provider Name (Legal Business Name): GRACE TO WIN COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 PARRISH ST
MATTHEWS NC
28105-8929
US

IV. Provider business mailing address

10625 PARRISH ST
MATTHEWS NC
28105-8929
US

V. Phone/Fax

Practice location:
  • Phone: 704-684-9505
  • Fax:
Mailing address:
  • Phone: 704-684-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANTE GREGORY
Title or Position: OWNER
Credential:
Phone: 704-340-7835