MEDICARE: NEW GRACE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1881542710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW GRACE WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2208 SAINT ANDREW ST
Second Line	:
City	:	TARBORO
State	:	NC
Zip	:	27886-2119
Country	:	US
Telephone Number	:	252-289-3778
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 SAINT ANDREW ST
Second Line	:
City	:	TARBORO
State	:	NC
Zip	:	27886-2119
Country	:	US
Telephone Number	:	252-289-3778
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALEXIS PEGUES
Credential	:	QMHP, CSAC
Telephone Number	:	252-289-3751

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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