Healthcare Provider Details

I. General information

NPI: 1205647385
Provider Name (Legal Business Name): AMAZING GRACE COUNSELING AND ADDICTION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 WINNESTE AVE
CINCINNATI OH
45232-1270
US

IV. Provider business mailing address

5670 WINNESTE AVE
CINCINNATI OH
45232-1270
US

V. Phone/Fax

Practice location:
  • Phone: 513-884-0917
  • Fax: 513-880-0519
Mailing address:
  • Phone: 513-884-0917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEONDRA MILLS
Title or Position: CEO
Credential:
Phone: 513-884-0917