Basic Information
| Provider Information | |||||||||
| NPI: | 1154963338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HONG | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9661 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912260661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108907950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 66 HURLBUT ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911054026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264414221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2019 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | ASW104560 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.