Provider Demographics
NPI:1235965708
Name:GRACE INTERNATIONAL CHURCHES AND MINISTRIES INC
Entity type:Organization
Organization Name:GRACE INTERNATIONAL CHURCHES AND MINISTRIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-265-3590
Mailing Address - Street 1:211 S LAZY LN
Mailing Address - Street 2:
Mailing Address - City:CLUTE
Mailing Address - State:TX
Mailing Address - Zip Code:77531-4434
Mailing Address - Country:US
Mailing Address - Phone:979-265-3590
Mailing Address - Fax:
Practice Address - Street 1:211 S LAZY LN
Practice Address - Street 2:
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531-4434
Practice Address - Country:US
Practice Address - Phone:979-265-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty