MEDICARE: AMAZING GRACE COUNSELING AND ADDICTION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	320800000X	Mental Illness Community Based Residential Treatment Facility
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1205647385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE COUNSELING AND ADDICTION SERVICES LLC

Provider Business Mailing Address
First Line	:	5670 WINNESTE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45232-1270
Country	:	US
Telephone Number	:	513-884-0917
Fax Number	:

Provider Business Practice Location Address
First Line	:	5670 WINNESTE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45232-1270
Country	:	US
Telephone Number	:	513-884-0917
Fax Number	:	513-880-0519

Authorized Official
Title or Position	:	CEO
Name	:	DEONDRA MILLS
Credential	:
Telephone Number	:	513-884-0917

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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