| Doctor Name: | CARLA GRACE |
| NPI Number: | 1073944559 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | LPC-5424 |
| Business Practice Address: | 506 N 4th Ave Sandpoint, ID - 838641513 |
| Business Phone Number: | 2082635393 |
| Business Fax Number: | 2082652301 |
| Mailing Address: | 506 N 4th Ave, SANDPOINT |
| State: | ID |
| Postal Code: | 838641513 |
| Phone Number: | 2082635393 |
| Fax Number: | 2082652301 |
| NPI Enumeration Date: | 12/09/2013 |
| NPI Last Update Date: | 12/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-5424 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |