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General NPI Number Information
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NPI Number | 1437781770
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Entity Type | Organization
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Legal Business Name | GRACIOUS COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 670 N ORLANDO AVE STE 103
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City | MAITLAND
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State | FL
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Zip | 32751-4465
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Country | US
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Telephone | 321-804-1439
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Fax |
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Provider Business Mailing Address
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Address Line | 5268 WELLINGTON PARK CIR APT A25
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City | ORLANDO
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State | FL
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Zip | 32839-4623
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Country | US
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Telephone | 407-572-9345
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY DONEGAN
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Credential | MSW, LCSW
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Telephone | 407-572-9345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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