GRACEFULLY CENTERED LLC NPI 1407458490

NPI Information

NPI: 1407458490
Provider Name: GRACEFULLY CENTERED, LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
2826 HILLCREEK DR
AUGUSTA, GA
ZIP 30909
Phone: (706) 210-2767
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GRACEFULLY CENTERED, LLC is a mental health (including community mental health center) clinic center in Augusta, GA. GRACEFULLY CENTERED, LLC NPI is 1407458490. The provider is registered as an organization entity type.

The provider's business location address is:

2826 HILLCREEK DR
AUGUSTA, GA
ZIP 30909-628
Phone: (706) 210-2767

The provider's authorized official is Ashley Maddox-wasington .
The authorized official title is Licensed Professional Counselor and has the following contact phone number (951) 956-8100.

The enumeration date for this NPI number is 11/13/2020 and was last updated on 11/13/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes
2	251S00000X	Community/Behavioral Health				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3335	OTHER	SOUTH CAROLINA	MEDICARE
2	421504	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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