# GRACE MEDICAL & WELLNESS CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609704840
- **Authorized official:** TINA NAYLOR (OWNER)
- **Authorized official phone:** (334) 580-0851

## Contact information

- **Practice address:** 1104 W 1ST ST STE 3, LAUREL, MS 39440-4357
- **Practice address phone:** (334) 580-0851
- **Mailing address:** 1104 W 1ST ST STE 3, LAUREL, MS 39440-4357
- **Mailing address phone:** (334) 580-0851

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | — | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/09/2026
- **Last updated:** 05/09/2026