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General NPI Number Information
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NPI Number | 1306240478
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Entity Type | Individual
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Provider Name | GRACE EUNHAE ROCK MA, LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 03/15/2020
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Provider Practice Location Address
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Address Line | 315 W PONCE DE LEON AVE STE 370
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City | DECATUR
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State | GA
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Zip | 30030-2476
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Country | US
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Telephone | 630-930-7059
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Fax |
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Provider Business Mailing Address
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Address Line | 435 HIGHLAND AVE NE UNIT 1425
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City | ATLANTA
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State | GA
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Zip | 30312-5315
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Country | US
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Telephone | 630-930-7059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LH 60666291
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC010931
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License Number State | GA
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