Provider Demographics
NPI:1699005728
Name:CHAVEZ GRANILLO, DIANNE E (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:E
Last Name:CHAVEZ GRANILLO
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 W 156TH ST SPC 50
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3541
Mailing Address - Country:US
Mailing Address - Phone:562-206-6148
Mailing Address - Fax:
Practice Address - Street 1:6108 AFTON PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8370
Practice Address - Country:US
Practice Address - Phone:323-461-4118
Practice Address - Fax:323-461-4119
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA071636101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)