Provider Demographics
NPI:1760364863
Name:JOHANNES, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LESHNER LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3843
Mailing Address - Country:US
Mailing Address - Phone:609-508-0402
Mailing Address - Fax:
Practice Address - Street 1:12 STULTS RD STE 137
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1549
Practice Address - Country:US
Practice Address - Phone:732-908-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)