Provider Demographics
NPI:1558991349
Name:MINDFUL GRACE COUNSELING PLLC
Entity Type:Organization
Organization Name:MINDFUL GRACE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-306-8507
Mailing Address - Street 1:57 PLAINS RD STE 3D
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2573
Mailing Address - Country:US
Mailing Address - Phone:203-551-9239
Mailing Address - Fax:
Practice Address - Street 1:57 PLAINS RD STE 3D
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-551-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health