Provider Demographics
NPI:1679649107
Name:BLEES, GRACIA D (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:GRACIA
Middle Name:D
Last Name:BLEES
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3371
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-3371
Mailing Address - Country:US
Mailing Address - Phone:803-548-7525
Mailing Address - Fax:803-548-0885
Practice Address - Street 1:1838 GOLD HILL RD
Practice Address - Street 2:SUITE 7
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6919
Practice Address - Country:US
Practice Address - Phone:803-548-7525
Practice Address - Fax:803-548-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3243101YP2500X
SC4218101YP2500X
NC925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist