Provider Demographics
NPI:1902453640
Name:HALLAK, GRACE (MRC, LPCC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HALLAK
Suffix:
Gender:F
Credentials:MRC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1604
Mailing Address - Country:US
Mailing Address - Phone:860-292-0038
Mailing Address - Fax:
Practice Address - Street 1:31 WELLS RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-1604
Practice Address - Country:US
Practice Address - Phone:860-292-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional