Healthcare Provider Details

I. General information

NPI: 1720804099
Provider Name (Legal Business Name): GRACIE C MORONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S SNODGRASS DR
PALMER AK
99645-9750
US

IV. Provider business mailing address

PO BOX 876646
WASILLA AK
99687-6646
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-6467
  • Fax:
Mailing address:
  • Phone: 907-745-6200
  • Fax: 907-745-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: