Provider Demographics
NPI:1629195441
Name:GRACE COUNSELING CENTER J. RAY ADDISON PH.D. PRT ET AL
Entity Type:Organization
Organization Name:GRACE COUNSELING CENTER J. RAY ADDISON PH.D. PRT ET AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-882-7600
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-1105
Mailing Address - Country:US
Mailing Address - Phone:864-882-7600
Mailing Address - Fax:864-882-7631
Practice Address - Street 1:530 BY PASS 123
Practice Address - Street 2:SUITE E2
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0859
Practice Address - Country:US
Practice Address - Phone:864-882-7600
Practice Address - Fax:864-882-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty