| Grace Family Services Inc | |
|
2406 Madison Dr North Myrtle Beach SC 29582-4334 | |
| (843) 663-0748 | |
| (843) 663-0749 |
| Full Name | Grace Family Services Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2406 Madison Dr, North Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Gene Smith (CEO) |
| Authorized Official Contact | 9103856424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Family Services Inc 2406 Madison Dr North Myrtle Beach SC 29582-4334 Ph: (843) 663-0748 | Grace Family Services Inc 2406 Madison Dr North Myrtle Beach SC 29582-4334 Ph: (843) 663-0748 |
| NPI Number | 1003549759 |
|---|---|
| Provider Enumeration Date | 07/08/2022 |
| Last Update Date | 07/22/2024 |
| Certification Date | 07/19/2022 |
| Medicare PECOS PAC ID | 5294274841 |
|---|---|
| Medicare Enrollment ID | O20241001000677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003549759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Primary |
| 251S00000X | Community/behavioral Health | () | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
| Provider Name | Cheryl B Hair |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780941930 PECOS PAC ID: 7416490172 Enrollment ID: I20240621003479 |
| Provider Name | Carleen Willeford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164641908 PECOS PAC ID: 6103879309 Enrollment ID: I20240926001814 |
| Provider Name | Mindy Mccarty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720643265 PECOS PAC ID: 6800219957 Enrollment ID: I20250521001254 |
| Provider Name | Toni Mendillo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295223519 PECOS PAC ID: 4587100607 Enrollment ID: I20250821000314 |
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