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General NPI Number Information
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NPI Number | 1780009357
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE COUNSELING LLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 6001 LAKESIDE AVE STE 30
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City | RICHMOND
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State | VA
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Zip | 23228-5749
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Country | US
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Telephone | 804-269-3837
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Fax |
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Provider Business Mailing Address
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Address Line | 6361 SPRINGCREST LN
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City | RICHMOND
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State | VA
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Zip | 23231-5326
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Country | US
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Telephone | 804-269-3878
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Fax | 804-269-3885
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. YVONNE NWINEMU NDIFOR-MCNEIL
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Credential | BA
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Telephone | 804-687-2097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1896-03-001
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License Number State | VA
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