Healthcare Provider Details

I. General information

NPI: 1275757122
Provider Name (Legal Business Name): GRACE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MADISON AVENUE
MADISON NJ
07940
US

IV. Provider business mailing address

16 MADISON AVENUE
MADISON NJ
07940
US

V. Phone/Fax

Practice location:
  • Phone: 973-822-0707
  • Fax: 973-822-2797
Mailing address:
  • Phone: 973-822-0707
  • Fax: 973-822-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: GARY E. MYERS
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, M.DIV. (MASTER
Phone: 973-822-0707