Healthcare Provider Details

I. General information

NPI: 1073422283
Provider Name (Legal Business Name): SUNGRACE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N PLUM ST
PONTIAC IL
61764-1803
US

IV. Provider business mailing address

207 N PLUM ST
PONTIAC IL
61764-1803
US

V. Phone/Fax

Practice location:
  • Phone: 815-791-2295
  • Fax:
Mailing address:
  • Phone: 815-791-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ASHLEY NICHOLE FRIZZELL
Title or Position: THERAPIST
Credential: LCSW, CADC
Phone: 815-791-2295