Healthcare Provider Details

I. General information

NPI: 1760130546
Provider Name (Legal Business Name): MOTIVATE WITH GRACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 SOUTH KINGS HW SUITE #204
ALEXANDRIA VA
22310
US

IV. Provider business mailing address

611 PENNSYLVANIA AVE SE # 498
WASHINGTON DC
20003-4303
US

V. Phone/Fax

Practice location:
  • Phone: 202-643-9413
  • Fax:
Mailing address:
  • Phone: 202-643-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MONET GRACE
Title or Position: OWNER
Credential: LCSW
Phone: 202-643-9413