Provider Demographics
NPI:1184027393
Name:GRACEY, AMY B (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:GRACEY
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 FOXHALL DR
Mailing Address - Street 2:APT F
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6723
Mailing Address - Country:US
Mailing Address - Phone:443-655-8068
Mailing Address - Fax:
Practice Address - Street 1:305 W CHESAPEAKE AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4421
Practice Address - Country:US
Practice Address - Phone:443-267-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health