Provider Demographics
NPI:1174389431
Name:GRACE AND RENEWAL LLC
Entity type:Organization
Organization Name:GRACE AND RENEWAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOLNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-558-6132
Mailing Address - Street 1:1835 PORTLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6362
Mailing Address - Country:US
Mailing Address - Phone:612-558-6132
Mailing Address - Fax:
Practice Address - Street 1:680 COMMERCE DR STE 271
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4512
Practice Address - Country:US
Practice Address - Phone:612-558-6132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)