Provider Demographics
NPI:1568930238
Name:REDEEMING GRACE COUNSELING PLLC
Entity Type:Organization
Organization Name:REDEEMING GRACE COUNSELING PLLC
Other - Org Name:REDEEMING GRACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LENORE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:701-353-9979
Mailing Address - Street 1:1351 PAGE DR S STE 202
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3536
Mailing Address - Country:US
Mailing Address - Phone:701-353-9979
Mailing Address - Fax:701-639-6501
Practice Address - Street 1:1351 PAGE DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3502
Practice Address - Country:US
Practice Address - Phone:701-353-9979
Practice Address - Fax:701-639-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-11
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12696273OtherCAQH
N711952OtherMEDICARE
ND19344Medicaid
1942625983OtherNPI