Provider Demographics
NPI:1841808060
Name:BY GRACE COUNSELING LLC
Entity type:Organization
Organization Name:BY GRACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKLIN-STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-827-8038
Mailing Address - Street 1:734 HEMINGWAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HEMINGWAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7024
Practice Address - Country:US
Practice Address - Phone:470-765-8393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health