Individual
CAROLINA GRADILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335-4219
(951) 643-2340
Mailing address
5580 MORENO ST SPC 49, MONTCLAIR, CA 91763-1601
(909) 261-9113
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
ASW93108
CA
Other
Enumeration date
01/29/2020
Last updated
01/29/2020
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