Healthcare Provider Details

I. General information

NPI: 1861031098
Provider Name (Legal Business Name): GRACE CONSULTING SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 S LINDEN RD STE 104
FLINT MI
48532-5487
US

IV. Provider business mailing address

2387 S LINDEN RD STE 104
FLINT MI
48532-5487
US

V. Phone/Fax

Practice location:
  • Phone: 810-875-0630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMASINE WORTHAM
Title or Position: CLINICAL DIRECTOR
Credential: LMSW
Phone: 810-875-0630