Provider Demographics
NPI:1841734878
Name:GRACE BEHAVIORAL HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA-JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MAC, CHAIS
Authorized Official - Phone:404-618-6955
Mailing Address - Street 1:145 CHURCH ST NE STE 285
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-0500
Mailing Address - Country:US
Mailing Address - Phone:404-619-6955
Mailing Address - Fax:
Practice Address - Street 1:145 CHURCH ST NE STE 285
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-0500
Practice Address - Country:US
Practice Address - Phone:404-619-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003676261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health