Healthcare Provider Details

I. General information

NPI: 1619540671
Provider Name (Legal Business Name): GRAYSTONE THERAPY & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 LUXE CENTER DR UNIT 424
MIDLOTHIAN VA
23114-1305
US

IV. Provider business mailing address

12300 ROCK HILL RD UNIT 2481
CHESTER VA
23831-2378
US

V. Phone/Fax

Practice location:
  • Phone: 210-549-7209
  • Fax:
Mailing address:
  • Phone: 210-549-7209
  • 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
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BELINDA MILLER
Title or Position: OWNER
Credential: LCSW
Phone: 210-549-7209