Provider Demographics
NPI:1558106146
Name:GRACEFUL JOURNEY THERAPY, LLC
Entity type:Organization
Organization Name:GRACEFUL JOURNEY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-344-8488
Mailing Address - Street 1:1209 HILL RD N STE 289
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7008
Mailing Address - Country:US
Mailing Address - Phone:614-344-8488
Mailing Address - Fax:
Practice Address - Street 1:140 W BORLAND ST STE 300
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1576
Practice Address - Country:US
Practice Address - Phone:614-344-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty