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General NPI Number Information
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NPI Number | 1821312679
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Entity Type | Organization
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Legal Business Name | NEW GRACE HOUSE COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 1724 VILLAGE WAY STE A
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City | ORANGE PARK
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State | FL
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Zip | 32073-5264
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Country | US
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Telephone | 904-269-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 STAFFORD DR
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City | ORANGE PARK
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State | FL
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Zip | 32073-5317
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Country | US
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Telephone | 904-881-5899
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MRS. FRANCES F NICHOLS
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Credential |
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Telephone | 904-881-5899
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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 |
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