Provider Demographics
NPI:1952430027
Name:FORD, DARRIIN GRADY (LMFT)
Entity type:Individual
Prefix:MR
First Name:DARRIIN
Middle Name:GRADY
Last Name:FORD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ATLANTIC AVE APT 910
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5150
Mailing Address - Country:US
Mailing Address - Phone:562-284-7077
Mailing Address - Fax:
Practice Address - Street 1:5353 E 2ND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5300
Practice Address - Country:US
Practice Address - Phone:562-284-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53733106H00000X
CA42778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist