MEDICARE: PLENTY AND GRACE, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1568810596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLENTY AND GRACE, LLC

Provider Business Mailing Address
First Line	:	1649 BLADEN UNION CHURCH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-9428
Country	:	US
Telephone Number	:	910-309-6569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 RAEFORD RD
Second Line	:	SUITE C
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5091
Country	:	US
Telephone Number	:	910-309-6569
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	TRACEY RAE FRINK
Credential	:	MS
Telephone Number	:	910-309-6569

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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Directions to “PLENTY AND GRACE, LLC ” Practice Location

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