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General NPI Number Information
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NPI Number | 1548136252
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Entity Type | Organization
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Legal Business Name | SUSTAINING GRACE COUNSELING, PLLC
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Dates
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Enumeration Date | 10/11/2025
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 2120 US HIGHWAY 190 W
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City | LIVINGSTON
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State | TX
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Zip | 77351-9602
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Country | US
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Telephone | 936-277-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 US HIGHWAY 190 W
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City | LIVINGSTON
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State | TX
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Zip | 77351-9602
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Country | US
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Telephone | 936-277-7235
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | AVA TRICIANNE KNEBEL
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Credential | LCSW
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Telephone | 936-239-7178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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