Grace Counseling & Mediation Services LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0701005309 Issued in VA

Legal business name

GRACE COUNSELING & MEDIATION SERVICES LLC

Practice address

2875 Chevoit Hill CT
Woodbridge, VA 22191

Phone

(703) 910-7529

Fax

(703) 910-7555

NPI assigned

Aug 13, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lottie Grace Olson-Davidson, PH.D.NPI 1528090016

Title

Owner

Phone

(703) 910-7529

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lottie Grace Olson-Davidson, PH.D., LPC, LCMHC

  • Mental Health Counselor
  • Dumfries, VA
  • NPI 1528090016
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1144476847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4222 FORTUNA CENTER PLZ STE 192",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220251515",
            "telephone_number": "703-910-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 CHEVOIT HILL CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22191",
            "telephone_number": "703-910-7529",
            "fax_number": "703-910-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE COUNSELING & MEDIATION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "OLSON-DAVIDSON",
        "authorized_official_first_name": "LOTTIE",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-910-7529",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701005309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Gordon, DPT
• Tai Michelle Gorecke, M.S.
• Nicole Gosda, MA- LPC-R
• Behnam M Goudarzi, M.D.
• Deepshikha Goyal, M.D.
• Grace Out Loud Therapy Services, LLC
• Grace Perinatal Associates, Inc.
• Gracestar Health Services LLC
• Gracestar Home Health LLC
• Gracetouch Psychiatry and Wellness PLLC

• Mental Health Counselor in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.