Provider Demographics
NPI:1720792559
Name:GRACEFUL GROWTH PROFESSIONAL COUNSELING LLC
Entity Type:Organization
Organization Name:GRACEFUL GROWTH PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-623-8193
Mailing Address - Street 1:230 EVENING WAY
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1178
Mailing Address - Country:US
Mailing Address - Phone:614-623-8193
Mailing Address - Fax:
Practice Address - Street 1:1565 BETHEL RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2005
Practice Address - Country:US
Practice Address - Phone:614-459-3003
Practice Address - Fax:614-459-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health