Provider Demographics
NPI:1407537103
Name:ALL GRACE THERAPEUTIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:ALL GRACE THERAPEUTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:TANASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:862-218-2646
Mailing Address - Street 1:545 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1722
Mailing Address - Country:US
Mailing Address - Phone:862-218-2646
Mailing Address - Fax:
Practice Address - Street 1:545 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1722
Practice Address - Country:US
Practice Address - Phone:862-218-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty