Individual
BROCK GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1400 OLD MILL CIR STE A, WINSTON SALEM, NC 27103-2977
(336) 893-7742
Mailing address
6220 THERMAL RD, CHARLOTTE, NC 28211-5630
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A12061
NC
Other
Enumeration date
06/30/2016
Last updated
08/13/2022
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