Provider Demographics
NPI:1639500515
Name:GRACE IN MOTION
Entity Type:Organization
Organization Name:GRACE IN MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWMER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:METZGAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-452-4673
Mailing Address - Street 1:3504 INDUSTRAIL AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-452-4673
Mailing Address - Fax:907-452-1430
Practice Address - Street 1:3504 INDUSTRIAL AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7376
Practice Address - Country:US
Practice Address - Phone:907-452-4673
Practice Address - Fax:907-452-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty