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MARVIN DARNELL GRADDY NPI 1144805011


NPI Information

NPI: 1144805011
Provider Name: MARVIN DARNELL GRADDY
Classification: Psychologist - 103TA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1320 ROCKSPRING WAY
ANTIOCH, CA
ZIP 94531
Phone: (925) 334-9906
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Marvin Darnell Graddy is an addiction (substance use disorder) psychologist in Antioch, CA. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. Marvin Darnell Graddy NPI is 1144805011. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1320 ROCKSPRING WAY
ANTIOCH, CA
ZIP 94531-397
Phone: (925) 334-9906

The enumeration date for this NPI number is 3/12/2021 and was last updated on 3/12/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YA0400XCounselorAddiction (Substance Use Disorder)101YA0400XCALIFORNIANo
2101YM0800XCounselorMental Health101YA0400XCALIFORNIANo
3103TA0400XPsychologistAddiction (Substance Use Disorder)101YA0400XCALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15VE8-FC6-UP53MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.