MEDICARE: THE GRACE SPACE COUNSELING AND WELLNESS 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1750251112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GRACE SPACE COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1700 NORTHSIDE DR NW STE A7
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2695
Country	:	US
Telephone Number	:	470-632-4799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 SHAWN WAYNE CIRCLE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316
Country	:	US
Telephone Number	:	470-632-4799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DE'LEON MARTIN
Credential	:	LPC
Telephone Number	:	470-632-4799

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	12/02/2025

Similar Medicare Providers

1144719485 — LISA MAGNANT CAIAFA NP
Practice Location Address:

745 MEMORIAL DR SE
ATLANTA, GA
30316

Practice Phone: 404-616-3815
Practice Fax:

1871423533 — CARSON HAGAN DPT
Practice Location Address:

1282 OAK GROVE AVE SE
ATLANTA, GA
30316-1618

Practice Phone: 912-704-2477
Practice Fax:

1215867908 — HAGAN STEP FORWARD THERAPY, LLC
Practice Location Address:

1282 OAK GROVE AVE SE
ATLANTA, GA
30316-1618

Practice Phone: 912-704-2477
Practice Fax:

1699553750 — AQIL ALYKHAN GILANI PT
Practice Location Address:

925 GARRETT ST SE STE J
ATLANTA, GA
30316-6833

Practice Phone: 404-624-5407
Practice Fax:

1558290775 — SARAH P CROZER RD, LD
Practice Location Address:

780 MEMORIAL DR SE APT 531
ATLANTA, GA
30316-1725

Practice Phone: 808-226-6213
Practice Fax:

1396608113 — LOLIYA J. STEWART, DDS, INC
Practice Location Address:

475 BILL KENNEDY WAY SE STE D
ATLANTA, GA
30316-6848

Practice Phone: 404-850-3424
Practice Fax: 404-850-3626

1194245704 — DR. LOLIYA JOY STEWART DDS
Practice Location Address:

475 BILL KENNEDY WAY SE STE D
ATLANTA, GA
30316-6848

Practice Phone: 404-850-3424
Practice Fax: 404-850-3626

Directions to “THE GRACE SPACE COUNSELING AND WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.