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General NPI Number Information
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NPI Number | 1811328826
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Entity Type | Organization
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Legal Business Name | WAVES OF GRACE COUNSELING, LLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 305 HANSON AVE STE 170
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3175
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Country | US
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Telephone | 540-361-4330
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Fax | 540-361-4331
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Provider Business Mailing Address
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Address Line | 305 HANSON AVE STE 170
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3175
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Country | US
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Telephone | 540-361-4330
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Fax | 540-361-4331
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MANION
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Credential | LPC
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Telephone | 804-338-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005506
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License Number State | VA
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