Individual
MARVIN DARNELL GRADDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1320 ROCKSPRING WAY, ANTIOCH, CA 94531-8397
(925) 334-9906
Mailing address
3707 SUNSET LN, ANTIOCH, CA 94509-6101
(925) 522-0124
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YA0400X
CA
101YM0800X
Mental Health Counselor
101YA0400X
CA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
101YA0400X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5VE8-FC6-UP53
—
CA
Enumeration date
03/12/2021
Last updated
03/12/2021
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