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General NPI Number Information
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NPI Number | 1578373767
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Entity Type | Individual
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Provider Name | GRACE ANNE LEADER MHC-LP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 6 WELLNESS WAY
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City | LATHAM
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State | NY
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Zip | 12110-2156
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Country | US
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Telephone | 518-782-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 17 WOODLAKE RD APT 1
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City | ALBANY
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State | NY
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Zip | 12203-3973
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Country | US
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Telephone | 516-670-6971
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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