Healthcare Provider Details

I. General information

NPI: 1255724092
Provider Name (Legal Business Name): CHARLES L GRAUSZ M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13218 WRENN HOUSE LN
OAK HILL VA
20171-3956
US

IV. Provider business mailing address

13218 WRENN HOUSE LN
OAK HILL VA
20171-3956
US

V. Phone/Fax

Practice location:
  • Phone: 703-643-3173
  • Fax:
Mailing address:
  • Phone: 703-643-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003964
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: