Healthcare Provider Details

I. General information

NPI: 1083435713
Provider Name (Legal Business Name): GED COUNSELING LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FAIR OAKS AVE
SOUTH PASADENA CA
91030-6204
US

IV. Provider business mailing address

1401 FAIR OAKS AVE
SOUTH PASADENA CA
91030-6204
US

V. Phone/Fax

Practice location:
  • Phone: 626-818-7401
  • Fax:
Mailing address:
  • Phone: 626-818-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: GRETA DURELLI
Title or Position: OWNER
Credential: LCSW
Phone: 626-644-1921