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General NPI Number Information
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NPI Number | 1356768675
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Entity Type | Organization
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Legal Business Name | GRACE ASSESSMENT AND THERAPY ASSOCIATES
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 13 E CLIFFORD ST
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City | WINCHESTER
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State | VA
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Zip | 22601-4609
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Country | US
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Telephone | 540-773-3999
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Fax | 540-773-3996
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Provider Business Mailing Address
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Address Line | 13 E CLIFFORD ST
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City | WINCHESTER
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State | VA
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Zip | 22601-4609
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Country | US
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Telephone | 540-773-3999
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Fax | 540-773-3996
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | JESSICA BROWN
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Credential | MA
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Telephone | 540-773-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 0803000056
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003713
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License Number State | VA
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