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General NPI Number Information
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NPI Number | 1205762069
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Entity Type | Organization
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Legal Business Name | GRACE PATH WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/19/2026
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Last Update Date | 06/19/2026
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Provider Practice Location Address
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Address Line | 1747 TYSONS CENTRAL ST APT 2302
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City | TYSONS
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State | VA
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Zip | 22182-6057
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Country | US
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Telephone | 925-775-8253
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Fax |
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Provider Business Mailing Address
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Address Line | 5709 EDGEWOOD AVE
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City | LYNCHBURG
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State | VA
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Zip | 24502-1903
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Country | US
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Telephone | 925-775-8253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCEL GRISARD
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Credential |
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Telephone | 925-775-8253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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