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General NPI Number Information
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NPI Number | 1083591796
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Entity Type | Organization
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Legal Business Name | GRACE HEALTH LLC
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 14110 ROBERT PARIS CT
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City | CHANTILLY
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State | VA
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Zip | 20151-4205
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Country | US
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Telephone | 703-378-7998
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Fax |
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Provider Business Mailing Address
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Address Line | 4925 JENNWAY LOOP
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City | MOSELEY
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State | VA
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Zip | 23120-1388
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Country | US
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Telephone | 804-912-7814
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM GREENE
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Credential |
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Telephone | 804-912-7814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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