Healthcare Provider Details

I. General information

NPI: 1154112324
Provider Name (Legal Business Name): GRACE HAVEN COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 10/09/2026
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CARRIAGE WAY
WINDSOR CT
06095
US

IV. Provider business mailing address

86 CARRIAGE WAY
WINDSOR CT
06095-2005
US

V. Phone/Fax

Practice location:
  • Phone: 781-870-0160
  • Fax:
Mailing address:
  • Phone: 781-870-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACY LAMERY
Title or Position: OWNER
Credential: LICSW
Phone: 781-308-2357