Provider Demographics
NPI:1215293402
Name:GRACE COUNSELING CENTERS
Entity type:Organization
Organization Name:GRACE COUNSELING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-277-6347
Mailing Address - Street 1:3707 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3412
Mailing Address - Country:US
Mailing Address - Phone:757-277-6347
Mailing Address - Fax:757-277-0181
Practice Address - Street 1:3707 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3412
Practice Address - Country:US
Practice Address - Phone:757-277-6347
Practice Address - Fax:757-277-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty