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1003113622
CHANNING GREDVIG
SAN DIEGO, CA
NPI
1003113622
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: CA 64651)
Enumeration Date
2011-02-16
Last Update Date
2021-11-29
Business Address
-- CHANNING GREDVIG LCSW
3420 KENYON ST
SAN DIEGO, CA 92110-5001
Phone number: 619-221-6550
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Mailing Address
-- CHANNING GREDVIG LCSW
3420 KENYON ST
SAN DIEGO, CA 92110-5001
Phone number: 619-221-6550
Copy
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