Healthcare Provider Details

I. General information

NPI: 1982489043
Provider Name (Legal Business Name): JENEICE CAPRI GASTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 185
CHICO CA
95926-2460
US

IV. Provider business mailing address

560 COHASSET RD STE 185
CHICO CA
95926-2460
US

V. Phone/Fax

Practice location:
  • Phone: 530-552-4958
  • Fax:
Mailing address:
  • Phone: 530-552-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI50740326
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: