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General NPI Number Information
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NPI Number | 1104780923
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Entity Type | Organization
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Legal Business Name | RENEWED BY GRACE THERAPY
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 408 N DUNCAN BYP STE 9
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City | UNION
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State | SC
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Zip | 29379-8663
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Country | US
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Telephone | 864-301-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 330 ZION CHURCH RD
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City | PACOLET
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State | SC
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Zip | 29372-2929
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Country | US
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Telephone | 864-301-5610
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | KEISA GREEN
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Credential | LPC
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Telephone | 864-301-5610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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