NPI 1003113622

Channing Gredvig, LCSW

Practitioner Clinical Social Worker San Diego, CA

Practice location

Address: 3420 Kenyon St, San Diego, CA 92110-5001
Phone: (619) 221-6550
Fax: (619) 221-6556

Registered specialties

Clinical Social Worker Primary

Behavioral Health & Social Service Providers Taxonomy 1041C0700X Licence 64651 (CA)

Other Social Worker providers in California →

Registry record

NPI: 1003113622
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Feb 2011
Record last updated: 29 Nov 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.