Provider Demographics
NPI:1972996387
Name:GRACE ABOUNDS COUNSELING & PSYCHOLOGICAL CONSULTIN
Entity Type:Organization
Organization Name:GRACE ABOUNDS COUNSELING & PSYCHOLOGICAL CONSULTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETUKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-696-8162
Mailing Address - Street 1:117 FRENEAU AVE
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NEW JERSEY
Mailing Address - Zip Code:07747
Mailing Address - Country:UM
Mailing Address - Phone:732-696-8162
Mailing Address - Fax:732-441-3866
Practice Address - Street 1:169 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4105
Practice Address - Country:US
Practice Address - Phone:732-939-0355
Practice Address - Fax:732-441-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00483400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty