Provider Demographics
NPI:1689812265
Name:CLARKE, GRANT DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:DAVID
Last Name:CLARKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1925 DALY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3309
Mailing Address - Country:US
Mailing Address - Phone:323-226-4448
Mailing Address - Fax:323-223-8380
Practice Address - Street 1:140 E COMMONWEALTH AVE STE 101
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1905
Practice Address - Country:US
Practice Address - Phone:714-773-4111
Practice Address - Fax:714-773-4222
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS246171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical