Healthcare Provider Details

I. General information

NPI: 1508047648
Provider Name (Legal Business Name): THERESA ANN GILLOTTI MA, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD STE 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

1420 WILLOW PASS RD STE 200
CONCORD CA
94520-5823
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5813
  • Fax: 925-646-5622
Mailing address:
  • Phone: 925-646-5813
  • Fax: 925-646-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 36296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: