Healthcare Provider Details

I. General information

NPI: 1386572097
Provider Name (Legal Business Name): GINA GREER GOLLARD PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 WELLESLEY ST STE 204
LA MESA CA
91942-4401
US

IV. Provider business mailing address

1207 ALAMEDA BLVD
CORONADO CA
92118-2710
US

V. Phone/Fax

Practice location:
  • Phone: 858-522-9438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: