Healthcare Provider Details

I. General information

NPI: 1871414839
Provider Name (Legal Business Name): TARYN RAYE GRASTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 CRESCENT CT
YORKTOWN VA
23693-4586
US

IV. Provider business mailing address

406 CRESCENT CT
YORKTOWN VA
23693-4586
US

V. Phone/Fax

Practice location:
  • Phone: 434-489-1697
  • Fax:
Mailing address:
  • Phone: 434-489-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016278
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: