Provider Demographics
NPI:1043671142
Name:GRACE VENTURES CORPORATION
Entity Type:Organization
Organization Name:GRACE VENTURES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:360-818-4376
Mailing Address - Street 1:16701 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3485
Mailing Address - Country:US
Mailing Address - Phone:360-818-4376
Mailing Address - Fax:360-326-7224
Practice Address - Street 1:16701 SE MCGILLIVRAY BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3485
Practice Address - Country:US
Practice Address - Phone:360-818-4376
Practice Address - Fax:360-326-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603388211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty