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General NPI Number Information
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NPI Number | 1306509732
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Entity Type | Organization
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Legal Business Name | GRACE CENTER FOR WELLNESS LLC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1 E ERIE ST STE 525-5017
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 708-381-0327
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Fax |
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Provider Business Mailing Address
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Address Line | 1 E ERIE ST STE 525-5017
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 312-204-7245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIONNEA SEALS
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Credential | LCPC
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Telephone | 312-204-7245
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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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