NPI 1053275206 · live from the CMS NPI Registry
Abundantly Graced Community Supportive Services INC
Peer Specialist in Charlotte, NC. National Provider Identifier 1053275206, active.
NPI record
| NPI | 1053275206 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Peer Specialist 175T00000X |
| Practice location | 5736 N Tryon St Ste 125a, Charlotte, NC 28213 |
| Practice phone | 704-713-5652 |
| Enumerated | December 11, 2025 |
| Last updated | March 11, 2026 |
| Authorized official | Lastarra Mcdonald, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | 385HR2060X | — |
| Case Management | 251B00000X | — |
| In Home Supportive Care | 253Z00000X | — |
| Adult Companion | 372600000X | — |
| Counselor, Addiction (Substance Use Disorder) | 101YA0400X | — |
| Community/Behavioral Health | 251S00000X | — |
| Home Health | 251E00000X | — |
| Meals | 174200000X | — |
| Counselor, Mental Health | 101YM0800X | — |
| Peer Specialist primary | 175T00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.