Healthcare Provider Details

I. General information

NPI: 1982399481
Provider Name (Legal Business Name): A GRACE LIKE RAIN COUNSELING SERVICES OF ALASKA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W SWANSON AVE
WASILLA AK
99654-6822
US

IV. Provider business mailing address

7362 W PARKS HWY # 339
WASILLA AK
99623-9300
US

V. Phone/Fax

Practice location:
  • Phone: 907-671-2884
  • Fax: 907-602-5102
Mailing address:
  • Phone: 907-671-2884
  • Fax: 907-600-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH BRIESE
Title or Position: BILLING DEPT
Credential:
Phone: 907-350-9870