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General NPI Number Information
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NPI Number | 1396345351
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Entity Type | Organization
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Legal Business Name | SPACE FOR GRACE, LLC
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 10208 CASCADE RUN CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5836
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Country | US
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Telephone | 443-985-7294
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Fax |
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Provider Business Mailing Address
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Address Line | 10208 CASCADE RUN CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5836
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Country | US
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Telephone | 443-985-7294
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RENEE P LEWIS
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Credential | LCPC, LCADC, NBCC
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Telephone | 443-889-2569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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