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General NPI Number Information
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NPI Number | 1356098370
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Entity Type | Organization
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Legal Business Name | CAROLINA GRACE COUNSELING
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 89 OLD TROLLEY RD STE 202
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City | SUMMERVILLE
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State | SC
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Zip | 29485-4951
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Country | US
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Telephone | 854-206-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 89 OLD TROLLEY RD STE 202
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City | SUMMERVILLE
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State | SC
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Zip | 29485-4951
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Country | US
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Telephone | 854-206-5513
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | DANIELLE J BAEZ
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Credential | MSW, LISW-CP
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Telephone | 419-699-2337
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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 |
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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