Healthcare Provider Details

I. General information

NPI: 1114864527
Provider Name (Legal Business Name): GRACE HOPPER STEM ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GRACE AVE
INGLEWOOD CA
90301-1306
US

IV. Provider business mailing address

601 GRACE AVE
INGLEWOOD CA
90301-1306
US

V. Phone/Fax

Practice location:
  • Phone: 310-910-0230
  • Fax: 310-388-1508
Mailing address:
  • Phone: 310-910-0230
  • Fax: 310-388-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA JONES
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 310-910-0230