Provider Demographics
NPI:1003405978
Name:GRACEWAY COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:GRACEWAY COUNSELING SERVICES LLC
Other - Org Name:GRACEWAY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:304-691-0873
Mailing Address - Street 1:33 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9485
Mailing Address - Country:US
Mailing Address - Phone:304-638-1551
Mailing Address - Fax:
Practice Address - Street 1:744 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1541
Practice Address - Country:US
Practice Address - Phone:304-691-0873
Practice Address - Fax:304-955-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care