Provider Demographics
NPI:1568810596
Name:PLENTY AND GRACE, LLC
Entity Type:Organization
Organization Name:PLENTY AND GRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:FRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:910-309-6569
Mailing Address - Street 1:1649 BLADEN UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9428
Mailing Address - Country:US
Mailing Address - Phone:910-309-6569
Mailing Address - Fax:
Practice Address - Street 1:2525 RAEFORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5091
Practice Address - Country:US
Practice Address - Phone:910-309-6569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)