Healthcare Provider Details

I. General information

NPI: 1104721091
Provider Name (Legal Business Name): CALIECE GAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S LAKESHORE DR STE 106
TEMPE AZ
85282-7156
US

IV. Provider business mailing address

2131 E BROADWAY RD STE 1
TEMPE AZ
85282-1737
US

V. Phone/Fax

Practice location:
  • Phone: 480-525-0058
  • Fax:
Mailing address:
  • Phone: 815-517-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: