Organization
GIVE GRACE YOUTH & FAMILY COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK M GRACE MS, LCMHC (OWNER & MANAGING MEMBER)
(336) 624-7866
Entity
Organization
Contact information
Practice address
1400 OLD MILL CIR STE A, WINSTON SALEM, NC 27103-2977
(336) 893-7742
Mailing address
1400 OLD MILL CIR STE A, WINSTON SALEM, NC 27103-2977
(336) 893-7742
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/06/2021
Last updated
02/22/2023
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