Provider Demographics
NPI:1659863256
Name:GRACE COUNSELING PLLC
Entity Type:Organization
Organization Name:GRACE COUNSELING PLLC
Other - Org Name:DANA M JONES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-955-3079
Mailing Address - Street 1:110 HUBER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6983
Mailing Address - Country:US
Mailing Address - Phone:601-955-3079
Mailing Address - Fax:601-506-9724
Practice Address - Street 1:598 YANDELL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8846
Practice Address - Country:US
Practice Address - Phone:601-506-9724
Practice Address - Fax:601-861-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1287101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03688237Medicaid