Provider Demographics
NPI:1215627591
Name:LANCASTER, GRACE HARRIS (LICSW, PIP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:HARRIS
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1897
Mailing Address - Country:US
Mailing Address - Phone:205-650-0576
Mailing Address - Fax:
Practice Address - Street 1:631 28TH AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1897
Practice Address - Country:US
Practice Address - Phone:205-650-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4770C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical