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General NPI Number Information
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NPI Number | 1164836417
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING, INC.
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Dates
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Enumeration Date | 06/15/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 701 E MAIN ST SUITE 3
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5247
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Country | US
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Telephone | 479-498-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E MAIN ST SUITE 3
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5247
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Country | US
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Telephone | 479-498-6700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AUDRA R PRINCE
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Credential | LCSW
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Telephone | 479-498-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2060C
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License Number State | AR
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