Provider Demographics
NPI:1164836417
Name:GRACE COUNSELING, INC.
Entity Type:Organization
Organization Name:GRACE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-498-6700
Mailing Address - Street 1:701 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5247
Mailing Address - Country:US
Mailing Address - Phone:479-498-6700
Mailing Address - Fax:
Practice Address - Street 1:701 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5247
Practice Address - Country:US
Practice Address - Phone:479-498-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-15
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2060C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health