Healthcare Provider Details

I. General information

NPI: 1508794744
Provider Name (Legal Business Name): GRACE COUNSELING & RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 1ST ST STE 4
LAUREL MS
39440-4357
US

IV. Provider business mailing address

1104 W 1ST ST STE 4
LAUREL MS
39440-4357
US

V. Phone/Fax

Practice location:
  • Phone: 601-651-6058
  • Fax: 601-651-6478
Mailing address:
  • Phone: 601-651-6058
  • Fax: 601-651-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. TINA NAYLOR
Title or Position: OWNER
Credential:
Phone: 334-580-0851