Healthcare Provider Details

I. General information

NPI: 1316871387
Provider Name (Legal Business Name): CARRIE GRACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S MAIN ST
CHAGRIN FALLS OH
44022-3225
US

IV. Provider business mailing address

14345 CAVES RD
NOVELTY OH
44072-9503
US

V. Phone/Fax

Practice location:
  • Phone: 216-536-2633
  • Fax:
Mailing address:
  • Phone: 216-536-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number165049
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: