Basic Information
| Provider Information | |||||||||
| NPI: | 1275757122 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRACE COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 MADISON AVENUE | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738220707 | ||||||||
| FaxNumber: | 9738222797 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 MADISON AVENUE | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738220707 | ||||||||
| FaxNumber: | 9738222797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 06/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9738220707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD, M.DIV. (MASTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP1600X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No ID Information.