| Doctor Name: | MISS BEVIN GRACY |
| NPI Number: | 1427397900 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | APC003749 |
| Business Practice Address: | 501 Mize St La Fayette, GA - 307283346 |
| Business Phone Number: | 7066385591 |
| Business Fax Number: | |
| Mailing Address: | 501 Mize St, LA FAYETTE |
| State: | GA |
| Postal Code: | 307283346 |
| Phone Number: | 7066385591 |
| Fax Number: | |
| NPI Enumeration Date: | 02/04/2013 |
| NPI Last Update Date: | 02/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | APC003749 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |