| Grace Space Counseling Llc | |
|
100 Walnut Ave Ste 210 Clark NJ 07066-1269 | |
| (732) 454-7810 | |
| (732) 454-7811 |
| Full Name | Grace Space Counseling Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 100 Walnut Ave Ste 210, Clark, New Jersey |
| Authorized Official Name and Position | Lizandra Portalatin (OWNER) |
| Authorized Official Contact | 7324547810 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Space Counseling Llc 100 Walnut Ave Ste 210 Clark NJ 07066-1269 Ph: (732) 454-7810 | Grace Space Counseling Llc 100 Walnut Ave Ste 210 Clark NJ 07066-1269 Ph: (732) 454-7810 |
| NPI Number | 1851119929 |
|---|---|
| Provider Enumeration Date | 09/28/2024 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/27/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851119929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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