Provider Demographics
NPI:1336359256
Name:GRIGGS, DIANE RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:RAE
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 W IMPERIAL HWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3143
Mailing Address - Country:US
Mailing Address - Phone:323-777-7610
Mailing Address - Fax:
Practice Address - Street 1:2930 W IMPERIAL HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3143
Practice Address - Country:US
Practice Address - Phone:323-777-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 119201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical