Organization
GIVING GRACE HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WILSON FNP-BC, PMHNP-BC (NURSE PRACTITIONER)
(410) 961-0897
Entity
Organization
Contact information
Practice address
77 E MAIN ST, WESTMINSTER, MD 21157-5037
(410) 961-0897
Mailing address
77 E MAIN ST STE 404, WESTMINSTER, MD 21157-6862
(410) 961-0897
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/01/2024
Last updated
11/04/2024
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