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Organization
GRAPE STREET COMMUNITY RESTORATION INC.
Active
Organization
GRAPE STREET COMMUNITY RESTORATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEBASTIAN DEE RANDOLPH STUDENT COUNSELOR (CLINICAL MENTAL HEALTH COUNSELOR)
(602) 736-7383
Entity
Organization
Contact information
Practice address
10139 BEACH ST APT 26A-3, LOS ANGELES, CA 90002-2978
(323) 801-6071
Mailing address
10139 BEACH ST APT 26A-3, LOS ANGELES, CA 90002-2978
(323) 801-6071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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