Provider Demographics
NPI:1972953941
Name:GRACEFUL WAY COUNSELING, LLC
Entity Type:Organization
Organization Name:GRACEFUL WAY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:QUIROGA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-571-5501
Mailing Address - Street 1:1035 S STATE ROAD 7 STE 315
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6137
Mailing Address - Country:US
Mailing Address - Phone:561-571-5501
Mailing Address - Fax:561-791-8039
Practice Address - Street 1:1035 S STATE ROAD 7 STE 315
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-571-5501
Practice Address - Fax:561-791-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12300101YM0800X
251S00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014645000Medicaid