Organization · NPI-2
Abundantly Graced Community Supportive Services INC
Peer Specialist · Charlotte, NC
NPI number1053275206
StatusActive
Last updated in NPPESMar 11, 2026
Details
- NPI
- 1053275206
- Entity type
- Organization (NPI-2)
- Legal business name
- Abundantly Graced Community Supportive Services INC
- Organization subpart
- No
- Enumeration date
- Dec 11, 2025
- Certification date
- Mar 11, 2026
- Last updated
- Mar 11, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | – | – | Yes |
| 385HR2060X | Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | – | – | |
| 251B00000X | Case Management | – | – | |
| 253Z00000X | In Home Supportive Care | – | – | |
| 372600000X | Adult Companion | – | – | |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 251S00000X | Community/Behavioral Health | – | – | |
| 251E00000X | Home Health | – | – | |
| 174200000X | Meals | – | – | |
| 101YM0800X | Counselor, Mental Health | – | – |
Practice location
5736 N Tryon St Ste 125aCharlotte, NC 28213-6886
Phone 704-713-5652
Mailing address
5736 N Tryon St Ste 125aCharlotte, NC 28213-6886
Phone 704-713-5652
Authorized official
Lastarra Shawnta Mcdonald
Ceo
7048191965
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