| Grace Counseling & Mediation Services Llc | |
|
2875 Chevoit Hill Ct Woodbridge VA 22191 | |
| (703) 910-7529 | |
| (703) 910-7555 |
| Full Name | Grace Counseling & Mediation Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 2875 Chevoit Hill Ct, Woodbridge, Virginia |
| Authorized Official Name and Position | Lottie Grace Olson-davidson (OWNER) |
| Authorized Official Contact | 7039107529 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Counseling & Mediation Services Llc 4222 Fortuna Center Plz Ste 192 Dumfries VA 22025-1515 Ph: (703) 910-7529 | Grace Counseling & Mediation Services Llc 2875 Chevoit Hill Ct Woodbridge VA 22191 Ph: (703) 910-7529 |
| NPI Number | 1144476847 |
|---|---|
| Provider Enumeration Date | 08/13/2008 |
| Last Update Date | 10/09/2024 |
| Certification Date | 10/04/2024 |
| Medicare PECOS PAC ID | 5991236408 |
|---|---|
| Medicare Enrollment ID | O20241008000435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144476847 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0701005309 (Virginia) | Primary |
| Provider Name | Lottie Grace Olson-davidson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528090016 PECOS PAC ID: 0244761757 Enrollment ID: I20241008000711 |
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