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General NPI Number Information
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NPI Number | 1922966746
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Entity Type | Organization
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Legal Business Name | GRACES ROOM LLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 10216 INDIAN SUMMER CT
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City | BOWIE
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State | MD
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Zip | 20721-3178
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Country | US
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Telephone | 240-203-7448
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Fax | 240-371-0557
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Provider Business Mailing Address
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Address Line | 3030 GREENMOUNT AVE STE 300
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City | BALTIMORE
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State | MD
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Zip | 21218-6907
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Country | US
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Telephone | 240-203-7448
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Fax | 240-371-0557
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | MICHAEL DICKSON
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Credential | DNP
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Telephone | 240-203-7448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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