Provider Demographics
NPI:1174019103
Name:RESTORING GRACE MENTAL HEALTH COUNSELING
Entity Type:Organization
Organization Name:RESTORING GRACE MENTAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND PSYCHOTHERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:518-242-9992
Mailing Address - Street 1:199 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1454
Mailing Address - Country:US
Mailing Address - Phone:518-242-9992
Mailing Address - Fax:
Practice Address - Street 1:7 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-8612
Practice Address - Country:US
Practice Address - Phone:518-242-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty