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General NPI Number Information
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NPI Number | 1356656516
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING MINISTRIES, INC.
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 73 NEWARK POMPTON TPKE
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City | RIVERDALE
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State | NJ
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Zip | 07457-1451
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Country | US
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Telephone | 973-835-2071
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Fax | 973-835-2083
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Provider Business Mailing Address
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Address Line | PO BOX 252
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City | PEQUANNOCK
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State | NJ
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Zip | 07440-0252
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Country | US
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Telephone | 973-835-2071
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Fax | 973-835-2083
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DAVID L BROWER
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Credential | MSW, LCSW
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Telephone | 973-835-2071
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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 | 44SC04571600
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License Number State | NJ
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