| NPI | 1407553043 |
|---|---|
| Doing Business As | PRIVATE PRACTICE |
| Entity Type | Organization |
| Authorized Contact | THOMAS GEORGE GRUBBA Owner 510-410-3519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-02-14 |