Healthcare Provider Details

I. General information

NPI: 1841734878
Provider Name (Legal Business Name): GRACE BEHAVIORAL HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CHURCH ST NE STE 105
MARIETTA GA
30060-1620
US

IV. Provider business mailing address

145 CHURCH ST NE STE 105
MARIETTA GA
30060-1620
US

V. Phone/Fax

Practice location:
  • Phone: 404-618-6955
  • Fax:
Mailing address:
  • Phone: 404-618-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberCSW003676
License Number StateGA

VIII. Authorized Official

Name: DONNA-JEAN OWENS
Title or Position: OWNER
Credential: LCSW
Phone: 404-618-6955