Provider Demographics
NPI:1881459253
Name:GVAZDINSKAS, GRACE MARIE (LAC, CSWC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:GVAZDINSKAS
Suffix:
Gender:F
Credentials:LAC, CSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 E TENNESSEE AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1693
Mailing Address - Country:US
Mailing Address - Phone:217-416-3199
Mailing Address - Fax:
Practice Address - Street 1:6795 E TENNESSEE AVE STE 370
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1693
Practice Address - Country:US
Practice Address - Phone:217-416-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002365101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)