Provider Demographics
NPI:1336956093
Name:GRACIOUS NUTRITION COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:GRACIOUS NUTRITION COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASTLES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:918-859-1258
Mailing Address - Street 1:3299 EDGEWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5931
Mailing Address - Country:US
Mailing Address - Phone:918-565-6375
Mailing Address - Fax:
Practice Address - Street 1:3299 EDGEWOOD DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5931
Practice Address - Country:US
Practice Address - Phone:918-565-6375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty