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General NPI Number Information
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NPI Number | 1508794744
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING & RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 05/09/2026
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Last Update Date | 05/09/2026
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Provider Practice Location Address
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Address Line | 1104 W 1ST ST STE 4
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City | LAUREL
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State | MS
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Zip | 39440-4357
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Country | US
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Telephone | 601-651-6058
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Fax | 601-651-6478
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Provider Business Mailing Address
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Address Line | 1104 W 1ST ST STE 4
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City | LAUREL
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State | MS
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Zip | 39440-4357
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Country | US
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Telephone | 601-651-6058
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Fax | 601-651-6478
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Authorized Official
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Title or Position | OWNER
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Name | DR. TINA NAYLOR
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Credential |
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Telephone | 334-580-0851
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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 | 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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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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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