Provider Demographics
NPI:1104301035
Name:GRACE COUNSELING SERVICE
Entity type:Organization
Organization Name:GRACE COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-283-1033
Mailing Address - Street 1:3 OFFICE PARK CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2534
Mailing Address - Country:US
Mailing Address - Phone:205-910-4573
Mailing Address - Fax:
Practice Address - Street 1:3 OFFICE PARK CIR STE 110
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2534
Practice Address - Country:US
Practice Address - Phone:205-910-4573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health