Provider Demographics
NPI:1710629951
Name:GRACE MENTAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:GRACE MENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:WINNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-974-5625
Mailing Address - Street 1:1885 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-2426
Mailing Address - Country:US
Mailing Address - Phone:248-974-5625
Mailing Address - Fax:
Practice Address - Street 1:141 N MILFORD RD STE 103
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4501
Practice Address - Country:US
Practice Address - Phone:248-974-5625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty