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General NPI Number Information
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NPI Number | 1821518382
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Entity Type | Organization
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Legal Business Name | GRACEWAY SERVICES, PC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12514 NC 242 HWY S
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City | BLADENBORO
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State | NC
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Zip | 28320-6026
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Country | US
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Telephone | 910-874-0769
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Fax |
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Provider Business Mailing Address
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Address Line | 12514 NC 242 HWY S
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City | BLADENBORO
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State | NC
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Zip | 28320-6026
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Country | US
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Telephone | 910-874-0769
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | TONI RAE BETHEA-BYRD
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Credential | LPC , LCAS-A
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Telephone | 910-874-0769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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