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General NPI Number Information
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NPI Number | 1780564294
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Entity Type | Organization
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Legal Business Name | GRACE & WELLNESS THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 626 CEDAR LN
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City | PONCHATOULA
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State | LA
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Zip | 70454-3908
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Country | US
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Telephone | 985-235-0709
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 W AIRLINE HWY # 1006
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City | LA PLACE
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State | LA
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Zip | 70068-3723
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Country | US
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Telephone | 985-307-5486
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Fax | 985-202-8427
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRACISHONE FLOYD
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Credential | PH.D, LPC,NCC
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Telephone | 504-333-9635
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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 |
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License Number State |
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