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General NPI Number Information
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NPI Number | 1497554695
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Entity Type | Organization
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Legal Business Name | UNDERGROUND GRIT
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1574 N BATAVIA ST STE 1
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City | ORANGE
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State | CA
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Zip | 92867-3543
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Country | US
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Telephone | 714-345-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 1574 N BATAVIA ST STE 1
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City | ORANGE
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State | CA
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Zip | 92867-3543
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Country | US
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Telephone | 714-345-2299
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Fax |
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Authorized Official
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Title or Position | CO-EXECUTIVE DIRECTOR
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Name | SUZANNE EILEEN CAMPBELL
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Credential | LCSW
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Telephone | 714-345-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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