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General NPI Number Information
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NPI Number | 1598216970
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Entity Type | Organization
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Legal Business Name | HARLEY GRACE LLC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 185 WOOSTER RD
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-2354
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Country | US
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Telephone | 910-585-9074
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Fax |
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Provider Business Mailing Address
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Address Line | 185 WOOSTER RD
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-2354
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Country | US
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Telephone | 910-585-9074
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSE MOREDOCK
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Credential | MA, LPC
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Telephone | 910-585-9074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8714
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License Number State | NC
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