1851956544 NPI number — GROWING BY GRACE COUNSELING SERVICES LLC

Table of content: (NPI 1851956544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851956544 NPI number — GROWING BY GRACE COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROWING BY GRACE COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851956544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 CARRICO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COAL GROVE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45638-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-442-1081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 DEPOT SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45638-1856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-550-1246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2019

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
JAMMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
740-442-1081

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0265786 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com