Provider Demographics
NPI:1871389320
Name:GERVAIS, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GERVAIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 S SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1450
Mailing Address - Country:US
Mailing Address - Phone:937-546-3271
Mailing Address - Fax:
Practice Address - Street 1:2124 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1450
Practice Address - Country:US
Practice Address - Phone:937-546-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor