Provider Demographics
NPI:1912220245
Name:GRACE HARBOUR, INC.
Entity Type:Organization
Organization Name:GRACE HARBOUR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:770-634-2490
Mailing Address - Street 1:2 LEE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1915
Mailing Address - Country:US
Mailing Address - Phone:770-486-1140
Mailing Address - Fax:678-669-2693
Practice Address - Street 1:2 LEE ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1915
Practice Address - Country:US
Practice Address - Phone:770-486-1140
Practice Address - Fax:678-669-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001104251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health