Healthcare Provider Details

I. General information

NPI: 1609780170
Provider Name (Legal Business Name): GRACEBORNE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 STATE ROUTE 18 STE C
NEW CASTLE PA
16105-3821
US

IV. Provider business mailing address

117 STATE ROUTE 18 STE C
NEW CASTLE PA
16105-3821
US

V. Phone/Fax

Practice location:
  • Phone: 330-314-0491
  • Fax:
Mailing address:
  • Phone: 330-314-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA M SHAW
Title or Position: SOLE MEMBER/OWNER
Credential: LPCC, LPC, MAC
Phone: 330-314-0491