Organization
GRACEFULLY CENTERED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY MADDOX-WASINGTON LPC (LICENSED PROFESSIONAL COUNSELOR)
(951) 956-8100
Entity
Organization
Contact information
Practice address
2826 HILLCREEK DR, AUGUSTA, GA 30909-5628
(706) 210-2767
Mailing address
PO BOX 495, GROVETOWN, GA 30813-0495
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3335
MEDICARE
SC
05
—
421504
—
SC
Enumeration date
11/13/2020
Last updated
11/13/2020
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