Kids of Grace, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC005074 Issued in GA

Legal business name

KIDS OF GRACE, INC.

Practice address

5262 Inverness CT
Douglasville, GA 30135-6748

Phone

(404) 604-4226

Fax

(888) 242-0387

NPI assigned

Oct 28, 2008

Last updated

Oct 28, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Antoinette Gooden, MS, LPC, NCC

Title

Executive Director

Phone

(404) 604-4226

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1245483973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6777",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301540030",
            "telephone_number": "404-604-4226",
            "fax_number": "888-242-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5262 INVERNESS CT",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301356748",
            "telephone_number": "404-604-4226",
            "fax_number": "888-242-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS OF GRACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "GOODEN",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "404-604-4226",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC005074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.