Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Abundantly Graced Community Supportive Services Inc

Organization Addiction (Substance Use Disorder) Counselor · NPI 1053275206

Abundantly Graced Community Supportive Services Inc is an Addiction (Substance Use Disorder) Counselor in Charlotte, North Carolina. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
10
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5736 N Tryon St Ste 125A
Charlotte, NC 28213-6886
Phone: (704) 713-5652
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X
Mental Health Counselor Taxonomy 101YM0800X
Meals Provider Taxonomy 174200000X
Case Management Agency Taxonomy 251B00000X
Home Health Agency Taxonomy 251E00000X
Community/Behavioral Health Agency Taxonomy 251S00000X
In Home Supportive Care Agency Taxonomy 253Z00000X
Adult Companion Taxonomy 372600000X
Child Intellectual and/or Developmental Disabilities Respite Care Taxonomy 385HR2060X

Record details

NPI number1053275206
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lastarra McDonald — Ceo · (704) 819-1965
NPI enumeratedDecember 11, 2025
Last updated in NPPESMarch 11, 2026
Certification dateMarch 11, 2026
Mailing address5736 N Tryon St Ste 125a, Charlotte, NC 28213-6886

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