Provider Demographics
NPI:1689763765
Name:PRICE, GRACE RILEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:RILEY
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 MARIETTA HWY
Mailing Address - Street 2:SUITE 132
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8212
Mailing Address - Country:US
Mailing Address - Phone:770-479-5501
Mailing Address - Fax:770-479-5502
Practice Address - Street 1:2920 MARIETTA HWY
Practice Address - Street 2:SUITE 132
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8212
Practice Address - Country:US
Practice Address - Phone:770-479-5501
Practice Address - Fax:770-479-5502
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBNVMedicare ID - Type UnspecifiedGA MEDICARE ID NUMBER