Healthcare Provider Details

I. General information

NPI: 1093631640
Provider Name (Legal Business Name): GRACE ADEL HEIMENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N BROAD ST E
ANGIER NC
27501-6573
US

IV. Provider business mailing address

120 N BROAD ST E
ANGIER NC
27501-6573
US

V. Phone/Fax

Practice location:
  • Phone: 919-772-1990
  • Fax: 919-772-1978
Mailing address:
  • Phone: 919-772-1990
  • Fax: 919-772-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP023887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: