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General NPI Number Information
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NPI Number | 1639325871
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Entity Type | Organization
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Legal Business Name | GUIDING GRACE COUNSELING LLC
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 547 1/2 S JAMES ST
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City | DOVER
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State | OH
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Zip | 44622-2137
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Country | US
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Telephone | 330-343-7400
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Fax | 330-343-7414
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Provider Business Mailing Address
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Address Line | PO BOX 534
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City | NEW PHILADELPHIA
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State | OH
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Zip | 44663-0534
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Country | US
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Telephone | 330-343-7400
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Fax | 330-343-7414
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. CONNIE LEE WALLACE
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Credential | LPCC-S, CTT
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Telephone | 330-343-7400
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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 | OH
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