Provider Demographics
NPI:1720404619
Name:GRACE POINT BEHAVIORAL LLC
Entity type:Organization
Organization Name:GRACE POINT BEHAVIORAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-224-0020
Mailing Address - Street 1:8439 CROSSLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8485
Mailing Address - Country:US
Mailing Address - Phone:334-409-9242
Mailing Address - Fax:334-409-9186
Practice Address - Street 1:8439 CROSSLAND LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8485
Practice Address - Country:US
Practice Address - Phone:334-409-9242
Practice Address - Fax:334-409-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26027261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)