Provider Demographics
NPI:1104664432
Name:WARD, GRACE ELAINA (LCPC-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELAINA
Last Name:WARD
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:ELAINA
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 MAIN ST # 18
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1339
Mailing Address - Country:US
Mailing Address - Phone:207-239-6406
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST # 18
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1339
Practice Address - Country:US
Practice Address - Phone:207-239-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health