Provider Demographics
NPI:1417578295
Name:WILLMS, GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WILLMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 DAVID TAYLOR DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0039
Mailing Address - Country:US
Mailing Address - Phone:727-349-4926
Mailing Address - Fax:727-498-2489
Practice Address - Street 1:1909 J N PEASE PL STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4546
Practice Address - Country:US
Practice Address - Phone:727-349-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical