Provider Demographics
NPI:1003322264
Name:GRACE COUNSELING CENTER
Entity Type:Organization
Organization Name:GRACE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-431-7866
Mailing Address - Street 1:209 SAN CARLOS AVE STE 111A
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1412
Mailing Address - Country:US
Mailing Address - Phone:407-431-7866
Mailing Address - Fax:
Practice Address - Street 1:209 SAN CARLOS AVE STE 111A
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1412
Practice Address - Country:US
Practice Address - Phone:407-431-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty