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General NPI Number Information
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NPI Number | 1134008071
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Entity Type | Organization
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Legal Business Name | UNTIL GRACE COUNSELING, PLLC
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 734 LANTERN REST LANE
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-750-4206
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8630
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-8630
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Country | US
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Telephone | 910-407-0930
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Fax | 910-668-3086
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Authorized Official
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Title or Position | OWNER
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Name | TAVON KERMEEN
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Credential | LCMHC
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Telephone | 910-407-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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