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Organization
GRACE BEHAVIORAL SUPPORT SERVICES FL
Active
Organization
GRACE BEHAVIORAL SUPPORT SERVICES FL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHANTALE MILORD-FERGUSON (DIRECTOR)
(786) 508-4148
Entity
Organization
Contact information
Practice address
780 FISHERMAN ST STE 210, OPA LOCKA, FL 33054-3807
(305) 681-2500
(305) 681-2525
Mailing address
780 FISHERMAN ST STE 250, OPA LOCKA, FL 33054-3807
(305) 681-2500
(305) 681-2525
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP1600X
Pastoral Counselor
—
—
101YS0200X
School Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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