Provider Demographics
NPI:1760828677
Name:GRACE COMMUNITY COUNSELING & SOCIAL SERVICES, LLC
Entity type:Organization
Organization Name:GRACE COMMUNITY COUNSELING & SOCIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTLIN-MONROY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-508-3552
Mailing Address - Street 1:3325 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1419
Mailing Address - Country:US
Mailing Address - Phone:678-508-3552
Mailing Address - Fax:
Practice Address - Street 1:777 CLEVELAND AVE SW STE 301
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7118
Practice Address - Country:US
Practice Address - Phone:678-508-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-18
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003620251S00000X
GALPC008821251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health