Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LR02501016 |
NPI | 1396305116 |
---|---|
Provider Name | Dr. Letha Grayson |
First Address | Long Beach, CA 90802-6137 |
Second Address | Lancaster, CA 93534-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 14/06/2019 |