Grace Harbour, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GRACE HARBOUR, INC

Practice address

200 Westpark Dr Ste 325
Peachtree City, GA 30269-3574

Phone

(770) 486-1140

Fax

(678) 669-2693

NPI assigned

Apr 17, 2007

Last updated

Sep 18, 2024By 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

Kevin FreemanNPI 1689741993

Title

Senior Vice President

Phone

(404) 934-9244

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Grace Harbour Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Grace Harbour Inc. Behavioral Health

  • Community/Behavioral Health Agency
  • Newnan, GA
  • NPI 1396097093
  NPD tax ID
• Grace Harbour, Inc.

  • Community/Behavioral Health Agency
  • Newnan, GA
  • NPI 1912220245
  NPD tax ID

Locations

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Winston Ramos Pineda, MD

  • Psychiatry Physician
  • Lagrange, GA
  • NPI 1831142546
  Medicare reassignment NPD
• Kevin Andrew Freeman, PHD, LPC, NCC, MAC

  • Professional Counselor
  • Peachtree City, GA
  • NPI 1689741993
  Authorized official Same address or phone
• Ashley Ann Bonvillain, LPC

  • Professional Counselor
  • Peachtree City, GA
  • NPI 1063753002
  NPD (past)
• Alison Hammonds Brown, LMSW

  • Social Worker
  • Peachtree City, GA
  • NPI 1114240801
  NPD (past)
• Michael John Credidio, PSYD

  • Psychologist
  • Newnan, GA
  • NPI 1669536405
  NPD (past)
• Jasmine Davis

  • Social Worker
  • Newnan, GA
  • NPI 1134849193

  Single Specialty

  NPD (past)
• Amy Marie Derose, MSW

  • Clinical Social Worker
  • Newnan, GA
  • NPI 1710652318
  NPD (past)
• Sara Oliver Dupree, L.P.C.

  • Professional Counselor
  • Sharpsburg, GA
  • NPI 1013305598
  NPD (past)
• Bethany Ann Fevella

  • Professional Counselor
  • Newnan, GA
  • NPI 1699644401
  NPD (past)
• Donna Kay Heinlen, LPC

  • Mental Health Counselor
  • Peachtree City, GA
  • NPI 1396951398
  NPD (past)
• Crystal Renay James, LPN

  • Licensed Practical Nurse
  • Newnan, GA
  • NPI 1447180450

  Single Specialty

  NPD (past)
• Jane Kearney, LAPC

  • Mental Health Counselor
  • Newnan, GA
  • NPI 1649893553
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1407072770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WESTPARK DR STE 325",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693574",
            "telephone_number": "770-486-1140",
            "fax_number": "678-669-2693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WESTPARK DR STE 325",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693574",
            "telephone_number": "770-486-1140",
            "fax_number": "678-669-2693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Main St Ste 1904",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292013200",
            "country_code": "US",
            "telephone_number": "770-486-1140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2411 N Oak St Ste 301E",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295773165",
            "country_code": "US",
            "telephone_number": "770-486-1140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "33 Market Point Dr Ste 2009",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296075768",
            "country_code": "US",
            "telephone_number": "770-486-1140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "37 Calumet Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302636734",
            "country_code": "US",
            "telephone_number": "770-304-0072",
            "fax_number": "678-669-2693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6650 Rivers Ave Ste 136",
            "address_purpose": "LOCATION",
            "city": "North Charleston",
            "state": "SC",
            "postal_code": "294064809",
            "country_code": "US",
            "telephone_number": "770-486-1140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACE HARBOUR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "404-934-9244"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "684485156A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "600073520",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7680934",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gatlin Glover, DMD
• Gomed, LLC
• Richelle Angela Gonzalez-Brown, M.D
• Shannon Gonzalez, L.AC
• Richard W Gorman, MD
• Grace Harbour, Inc.
• Bridget Grady
• Sharon R Grant, LPC
• Brittani Marie Gray, LPC
• Hannah Gray, RPH

• Community/Behavioral Health Agency in Peachtree City, GA
• Providers in Peachtree City, 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 Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.