Healthcare Provider Details

I. General information

NPI: 1386568533
Provider Name (Legal Business Name): GRACE COLLECTIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 DARBY RD APT 312
HAVERTOWN PA
19083-2240
US

IV. Provider business mailing address

2323 DARBY RD APT 312
HAVERTOWN PA
19083-2240
US

V. Phone/Fax

Practice location:
  • Phone: 484-477-2426
  • Fax:
Mailing address:
  • Phone: 484-477-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GRACIE RAE HODGES
Title or Position: FOUNDER
Credential: LPC
Phone: 310-912-1825