Provider Demographics
NPI:1710616883
Name:WITH GRACE COUNSELING PLLC
Entity Type:Organization
Organization Name:WITH GRACE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, MA
Authorized Official - Phone:615-945-5882
Mailing Address - Street 1:659 W RANDOLPH ST APT 1808
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2252
Mailing Address - Country:US
Mailing Address - Phone:615-945-5882
Mailing Address - Fax:
Practice Address - Street 1:659 W RANDOLPH ST APT 1808
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2252
Practice Address - Country:US
Practice Address - Phone:615-945-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health