Provider Demographics
NPI:1801769377
Name:SERGEANT, GRACE LOVE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LOVE
Last Name:SERGEANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 BAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4665
Mailing Address - Country:US
Mailing Address - Phone:206-972-8103
Mailing Address - Fax:
Practice Address - Street 1:16430 BAKE PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4665
Practice Address - Country:US
Practice Address - Phone:714-388-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician