Provider Demographics
NPI:1639318652
Name:SAVING GRACE BEHAVIOR HEALTH SERVICES
Entity Type:Organization
Organization Name:SAVING GRACE BEHAVIOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:YEBOA
Authorized Official - Last Name:SIAKWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCAS, CCS, LCSWP
Authorized Official - Phone:252-268-5433
Mailing Address - Street 1:1951A CAMBRIA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0094
Mailing Address - Country:US
Mailing Address - Phone:252-268-5433
Mailing Address - Fax:
Practice Address - Street 1:1951A CAMBRIA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0094
Practice Address - Country:US
Practice Address - Phone:252-353-7147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-14
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111899Medicaid