Individual
CARLOS GRILEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
204 HAMPTON DR, VENICE, CA 90291-2623
(310) 309-6001
Mailing address
204 HAMPTON DR, VENICE, CA 90291-2623
(310) 309-6001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2889
CA
Other
Enumeration date
08/23/2016
Last updated
08/26/2016
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