Provider Demographics
NPI:1871291518
Name:GRACE PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:GRACE PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:505-205-6397
Mailing Address - Street 1:8200 GREENSBORO DR STE 900
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4931
Mailing Address - Country:US
Mailing Address - Phone:703-665-9613
Mailing Address - Fax:
Practice Address - Street 1:8200 GREENSBORO DR STE 900
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4931
Practice Address - Country:US
Practice Address - Phone:703-665-9613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)