Healthcare Provider Details

I. General information

NPI: 1093578809
Provider Name (Legal Business Name): DARIN GRANT JAMES CADC 1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 42ND ST
SAN DIEGO CA
92105-1506
US

IV. Provider business mailing address

4017 42ND ST
SAN DIEGO CA
92105-1506
US

V. Phone/Fax

Practice location:
  • Phone: 619-236-9217
  • Fax: 619-236-9217
Mailing address:
  • Phone: 619-236-9217
  • Fax: 619-236-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI48970925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: