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General NPI Number Information
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NPI Number | 1245690080
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Entity Type | Organization
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Legal Business Name | GRACE ANTHONY COUNSELING, LLC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 3915 CASCADE RD SW STE 240
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City | ATLANTA
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State | GA
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Zip | 30331-8512
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Country | US
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Telephone | 404-604-1964
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 STEWART PKWY P.O. BOX 5165
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City | DOUGLASVILLE
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State | GA
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Zip | 30154-1128
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Country | US
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Telephone | 404-604-1962
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | CHA'KE'SHA SPENCER
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Credential | LPC
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Telephone | 404-604-1962
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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 | LPC004886
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License Number State | GA
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