=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760204770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRIT AND GRACE COUNSELING GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2024
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1703 BELLE VIEW BLVD APT B2
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22307-6725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-668-3285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8617 LOMBARDY LN
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22308-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-668-3285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | ELIZABETH JOSEPH WELCH
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 609-668-3285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------