Organization
GRACELAND STUDENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRYSTLE M. JOHNSON (CO-OWNER)
(919) 593-7324
Entity
Organization
Contact information
Practice address
610 FAIRVIEW AVE., WILSON, NC 27893
(919) 593-7324
Mailing address
P.O. BOX 31, WILSON, NC 27894
(919) 593-7324
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
09/30/2020
Last updated
08/07/2024
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