Provider Demographics
NPI:1023849312
Name:AMAZING GRACE PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:AMAZING GRACE PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KWIECINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:540-228-0198
Mailing Address - Street 1:25 TINKLING SPRING RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2261
Mailing Address - Country:US
Mailing Address - Phone:540-228-0198
Mailing Address - Fax:276-241-0647
Practice Address - Street 1:25 TINKLING SPRING RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2261
Practice Address - Country:US
Practice Address - Phone:540-228-0198
Practice Address - Fax:276-241-0647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty