MEDICARE: LED BY GRACE, LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518854512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LED BY GRACE, LLC.

Provider Business Mailing Address
First Line	:	710 CHESWICK AVE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-7079
Country	:	US
Telephone Number	:	704-629-8756
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 CHESWICK AVE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-7079
Country	:	US
Telephone Number	:	704-629-8756
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DOMINIQUE CRAWFORD
Credential	:	LCSW, LCAS
Telephone Number	:	704-629-8756

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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Directions to “LED BY GRACE, LLC. ” Practice Location

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