Provider Demographics
NPI:1821518382
Name:GRACEWAY SERVICES, PC
Entity Type:Organization
Organization Name:GRACEWAY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BETHEA-BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC , LCAS-A
Authorized Official - Phone:910-874-0769
Mailing Address - Street 1:12514 NC 242 HWY S
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-6026
Mailing Address - Country:US
Mailing Address - Phone:910-874-0769
Mailing Address - Fax:
Practice Address - Street 1:12514 NC 242 HWY S
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-6026
Practice Address - Country:US
Practice Address - Phone:910-874-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1568Medicaid
NC13016236658OtherNPPES