Organization
GRACE SPACE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LIZANDRA PORTALATIN LPC (OWNER)
(732) 454-7810
Entity
Organization
Contact information
Practice address
100 WALNUT AVE STE 210, CLARK, NJ 07066-1269
(732) 454-7810
(732) 454-7811
Mailing address
100 WALNUT AVE STE 210, CLARK, NJ 07066-1269
(732) 454-7810
(732) 454-7811
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/28/2024
Last updated
01/27/2025
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