Provider Demographics
NPI:1154954725
Name:GRACE AUTISM SERVICES INC
Entity type:Organization
Organization Name:GRACE AUTISM SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-434-4343
Mailing Address - Street 1:1 DIAMOND CAUSEWAY
Mailing Address - Street 2:SUITE 21 - 121
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-9515
Mailing Address - Country:US
Mailing Address - Phone:912-434-4343
Mailing Address - Fax:912-452-9600
Practice Address - Street 1:1481 DEAN FOREST RD # BUILD100
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9342
Practice Address - Country:US
Practice Address - Phone:912-434-4343
Practice Address - Fax:912-452-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508255365OtherNPI
1-14-9630OtherBEHAVIOR ANALYST CERTIFICATION BOARD
1-23-65473OtherBEHAVIOR ANALYST CERTIFICATION BOARD
1699216648OtherNPI
GA1-19-34978OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BCBA)
1124638150OtherNPI