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General NPI Number Information
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NPI Number | 1053009159
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Entity Type | Individual
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Provider Name | GRACE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 2008 BREMO ROAD SUITE 111
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City | RICHMOND
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State | VA
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Zip | 23226-4705
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Country | US
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Telephone | 804-223-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 9 E LEIGH ST APT A
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City | RICHMOND
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State | VA
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Zip | 23219-1371
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Country | US
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Telephone | 804-306-5734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0704015846
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License Number State | VA
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