Provider Demographics
NPI:1306240478
Name:ROCK, GRACE EUNHAE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:EUNHAE
Last Name:ROCK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:EUNHAE
Other - Last Name:WHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC, LPC
Mailing Address - Street 1:435 HIGHLAND AVE NE UNIT 1425
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-5315
Mailing Address - Country:US
Mailing Address - Phone:630-930-7059
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 370
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2476
Practice Address - Country:US
Practice Address - Phone:630-930-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60666291101YM0800X
GALPC010931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health