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General NPI Number Information
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NPI Number | 1174389431
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Entity Type | Organization
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Legal Business Name | GRACE AND RENEWAL LLC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 680 COMMERCE DR STE 271
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City | WOODBURY
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State | MN
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Zip | 55125-4512
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Country | US
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Telephone | 612-558-6132
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 PORTLAND AVE APT 3
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City | SAINT PAUL
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State | MN
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Zip | 55104-6362
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Country | US
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Telephone | 612-558-6132
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH THERAPIST
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Name | KARA LYNN DOLNEY
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Credential | LPCC
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Telephone | 612-558-6132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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