Provider Demographics
NPI:1407359045
Name:GRACE FROM DARKNESS, PLLC
Entity Type:Organization
Organization Name:GRACE FROM DARKNESS, PLLC
Other - Org Name:DEYANIRA BALDERA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DEYANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-872-8456
Mailing Address - Street 1:1515 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6096
Mailing Address - Country:US
Mailing Address - Phone:718-872-8456
Mailing Address - Fax:
Practice Address - Street 1:1515 N UNIVERSITY DR STE 102A
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6083
Practice Address - Country:US
Practice Address - Phone:718-872-8456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13131101Y00000X, 101YA0400X, 101YM0800X, 251B00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management