Organization
ABUNDANTLY GRACED COMMUNITY SUPPORTIVE SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LASTARRA SHAWNTA MCDONALD (CEO)
(704) 819-1965
Entity
Organization
Contact information
Practice address
5736 N TRYON ST STE 125A, CHARLOTTE, NC 28213-6886
(704) 713-5652
Mailing address
5736 N TRYON ST STE 125A, CHARLOTTE, NC 28213-6886
(704) 713-5652
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106S00000X
Behavior Technician
—
—
171400000X
Health & Wellness Coach
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
174200000X
Meals Provider
—
—
175T00000X
Peer Specialist
Primary
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
372600000X
Adult Companion
—
—
374U00000X
Home Health Aide
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
12/11/2025
Last updated
03/11/2026
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