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General NPI Number Information
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NPI Number | 1659863256
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING PLLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 598 YANDELL RD
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City | CANTON
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State | MS
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Zip | 39046-8846
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Country | US
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Telephone | 601-506-9724
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Fax | 601-861-4924
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Provider Business Mailing Address
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Address Line | 110 HUBER ST
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City | MADISON
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State | MS
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Zip | 39110-6983
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Country | US
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Telephone | 601-955-3079
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Fax | 601-506-9724
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | DANA MICHELLE JONES
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Credential | LPC
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Telephone | 601-955-3079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1287
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License Number State | MS
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