Healthcare Provider Details

I. General information

NPI: 1356266480
Provider Name (Legal Business Name): GRACEFUL GROWTH SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S MAIN ST APT 12
HOPEWELL VA
23860-3916
US

IV. Provider business mailing address

117 S MAIN ST APT 12
HOPEWELL VA
23860-3916
US

V. Phone/Fax

Practice location:
  • Phone: 804-510-8897
  • Fax:
Mailing address:
  • Phone: 804-510-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DARNITA MICHELLE JEFFERSON
Title or Position: OWNER
Credential:
Phone: 804-510-8897