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General NPI Number Information
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NPI Number | 1902453640
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Entity Type | Individual
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Provider Name | GRACE HALLAK MRC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 144 PROSPECT HILL RD
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City | EAST WINDSOR
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State | CT
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Zip | 06088-9618
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Country | US
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Telephone | 859-474-0479
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MARSHALL DR
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City | ENFIELD
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State | CT
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Zip | 06082-3013
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Country | US
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Telephone | 860-818-2080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 252371
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License Number State | KY
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