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Organization
GREY SPACE THERAPY, LCSW PROFESSIONAL CORPORATION
Active
Organization
GREY SPACE THERAPY, LCSW PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FABIOLA PACHECO LCSW (FOUNDER)
(714) 749-5554
Entity
Organization
Contact information
Practice address
5055 CANYON CREST DR STE 216, RIVERSIDE, CA 92507-6015
(714) 749-5554
Mailing address
5744 CREST AVE, RIVERSIDE, CA 92503-8634
(714) 749-5554
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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