NPIMap

Organization Active NPI

Give Grace Youth & Family Counseling, PLLC

  • Community/Behavioral Health Agency
  • Winston Salem, NC
National Provider Identifier
1336710979
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GIVE GRACE YOUTH & FAMILY COUNSELING, PLLC
Practice address
1400 Old Mill Cir Ste a
Winston Salem, NC 27103-2977
Phone
(336) 893-7742
NPI assigned
Jul 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Authorized official

Name
Brock M Grace, MS, LCMHCNPI 1659722692
Title
Owner & Managing Member
Phone
(336) 624-7866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Community/Behavioral Health Agency 251S00000X Primary
Clinic/Center 261Q00000X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1400 Old Mill Cir Ste a
Winston Salem, NC 27103-2977

Mailing address

1400 Old Mill Cir Ste a
Winston Salem, NC 27103-2977
Phone (336) 893-7742

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250911004033 NC Part B Supplier - Clinic/Group Practice 6103329537 Receives reassigned benefits from 1 practitioner
Practice locations: Winston Salem, NC

National Provider Directory

National Provider Directory

Locations

1400 Old Mill Cir
Ste A
Winston Salem, NC 27103
Phone (336) 893-7742

3447 Robinhood Rd
Ste 206
Winston Salem, NC 27106

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1336710979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 OLD MILL CIR STE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032977",
            "telephone_number": "336-893-7742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 OLD MILL CIR STE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032977",
            "telephone_number": "336-893-7742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIVE GRACE YOUTH & FAMILY COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-06",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "GRACE",
        "authorized_official_first_name": "BROCK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER & MANAGING MEMBER",
        "authorized_official_telephone_number": "336-624-7866",
        "authorized_official_credential": "MS, LCMHC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.