Organization · NPI-2

Grace Nova Counseling

Clinic/Center, Mental Health (Including Community Mental Health Center) · Vienna, VA

NPI number1649838285
StatusActive
Last updated in NPPESJun 11, 2019

Details

NPI
1649838285
Entity type
Organization (NPI-2)
Legal business name
Grace Nova Counseling
Organization subpart
No
Enumeration date
May 29, 2019
Last updated
Jun 11, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

8227 Old Courthouse Rd Ste 215
Vienna, VA 22182-3815

Phone 571-230-3019

Mailing address

8227 Old Courthouse Rd Ste 215
Vienna, VA 22182-3815

Phone 571-230-3019

Authorized official

Kelly Lutrell Stephenson
Licensed Mental Health Counselor
5712303019

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