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General NPI Number Information
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NPI Number | 1619889011
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Entity Type | Organization
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Legal Business Name | GRACE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 1830 MACMILLAN PARK DR STE 111
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City | FORT MILL
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State | SC
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Zip | 29707-7712
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Country | US
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Telephone | 803-701-9919
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 MACMILLAN PARK DR STE 111
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City | FORT MILL
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State | SC
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Zip | 29707-7712
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Country | US
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Telephone | 803-701-9919
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RAQUEL SMITH
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Credential | DBA,MS
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Telephone | 704-261-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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