Provider Demographics
NPI:1851956544
Name:GROWING BY GRACE COUNSELING SERVICES
Entity Type:Organization
Organization Name:GROWING BY GRACE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC
Authorized Official - Phone:740-442-1081
Mailing Address - Street 1:103 CARRICO DR
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-3006
Mailing Address - Country:US
Mailing Address - Phone:740-442-1081
Mailing Address - Fax:
Practice Address - Street 1:615 DEPOT SQ
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1856
Practice Address - Country:US
Practice Address - Phone:740-550-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0265786Medicaid