Provider Information for 1578019386
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NADIA GRISSOM LCSW 125270
Sex: Female
NPI: 1578019386
Last Updated: 2024-10-01
Certification Date: 2024-10-01
Certification Date: 2024-10-01
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1578019386 | ||||||||||||||||
| Enumeration Date | 2016-08-31 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 333 S BEAUDRY AVE LOS ANGELES, CA 90017-1466 United States Phone: 213-241-3841 | Fax:213-241-3305 | ||||||||||||||||
| Primary Practice Address | 333 S BEAUDRY AVE LOS ANGELES, CA 90017-1466 United States Phone: 213-241-3841 | Fax:213-241-3305 | ||||||||||||||||
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