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General NPI Number Information
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NPI Number | 1205647385
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE COUNSELING AND ADDICTION SERVICES LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 5670 WINNESTE AVE
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City | CINCINNATI
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State | OH
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Zip | 45232-1270
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Country | US
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Telephone | 513-884-0917
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Fax | 513-880-0519
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Provider Business Mailing Address
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Address Line | 5670 WINNESTE AVE
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City | CINCINNATI
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State | OH
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Zip | 45232-1270
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Country | US
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Telephone | 513-884-0917
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DEONDRA MILLS
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Credential |
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Telephone | 513-884-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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