Organization
GRACE HARBOUR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN FREEMAN (SENIOR VICE PRESIDENT)
(404) 934-9244
Entity
Organization
Contact information
Practice address
200 WESTPARK DR STE 325, PEACHTREE CITY, GA 30269-3574
(770) 486-1140
(678) 669-2693
Mailing address
200 WESTPARK DR STE 325, PEACHTREE CITY, GA 30269-3574
(770) 486-1140
(678) 669-2693
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600073520
MAGELLAN
—
05
—
684485156A
—
GA
01
—
7680934
AETNA
—
Enumeration date
04/17/2007
Last updated
09/18/2024
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