Provider Demographics
NPI:1568919983
Name:GRACE COUNSELING & PSYCHOTHERAPY INC.
Entity Type:Organization
Organization Name:GRACE COUNSELING & PSYCHOTHERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MDIV, THM
Authorized Official - Phone:619-381-8472
Mailing Address - Street 1:5700 BALTIMORE DR
Mailing Address - Street 2:UNIT 161
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1616
Mailing Address - Country:US
Mailing Address - Phone:619-405-4980
Mailing Address - Fax:
Practice Address - Street 1:135 E 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4252
Practice Address - Country:US
Practice Address - Phone:619-381-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PSY24462OtherLICENSE