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General NPI Number Information
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NPI Number | 1194431429
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Entity Type | Organization
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Legal Business Name | GRACEFUL CHANGES PSYCHOTHERAPY
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 1201 ROSE GALAXY LNDG #301
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456
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Country | US
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Telephone | 757-689-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 ROSE GALAXY LNDG APT 301
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-7773
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Country | US
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Telephone | 757-689-7971
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAE WINTERS
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Credential | LPC
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Telephone | 757-689-7971
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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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