Healthcare Provider Details

I. General information

NPI: 1053257964
Provider Name (Legal Business Name): NICOLE THERESE GANTNEY ASW, MSW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI GANTNEY ASW, MSW, PPSC

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HARRIS ST
EUREKA CA
95503-4448
US

IV. Provider business mailing address

624 HARRIS ST
EUREKA CA
95503-4448
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-2051
  • Fax: 707-445-6124
Mailing address:
  • Phone: 707-441-2051
  • Fax: 707-445-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number379038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: