MEDICARE: EBONY GRACE WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1376410084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBONY GRACE WELLNESS

Provider Business Mailing Address
First Line	:	6456 OXBRIDGE DR
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-1793
Country	:	US
Telephone Number	:	410-200-0953
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 PHILLIP MORRIS DR STE 204B
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-2000
Country	:	US
Telephone Number	:	410-200-0953
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. TINEKA CHANTEY HARMON
Credential	:	LCSW-C
Telephone Number	:	301-524-3617

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	02/13/2026

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Directions to “EBONY GRACE WELLNESS ” Practice Location

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