Provider Demographics
NPI:1154624997
Name:BRACE, CAROLE (MA, RN)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:BRACE
Suffix:
Gender:F
Credentials:MA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3868
Mailing Address - Country:US
Mailing Address - Phone:765-662-9971
Mailing Address - Fax:
Practice Address - Street 1:101 S WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3868
Practice Address - Country:US
Practice Address - Phone:765-662-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health