Provider Demographics
NPI:1013559012
Name:GRACE HOPE COUNSELING OF FLORIDA, PLLC
Entity Type:Organization
Organization Name:GRACE HOPE COUNSELING OF FLORIDA, PLLC
Other - Org Name:GRACE COUNSELING SERVICES OF WINTER HAVEN, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAKITA
Authorized Official - Middle Name:WATKINS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW, MA
Authorized Official - Phone:863-662-4191
Mailing Address - Street 1:111 W CENTRAL AVE # 956
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-8001
Mailing Address - Country:US
Mailing Address - Phone:863-210-9473
Mailing Address - Fax:863-588-3152
Practice Address - Street 1:99 6TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-7902
Practice Address - Country:US
Practice Address - Phone:863-662-4191
Practice Address - Fax:863-588-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326315979OtherLCSW