Healthcare Provider Details

I. General information

NPI: 1316505399
Provider Name (Legal Business Name): GABRIELLE M LOOMIS-ANNETT LPC, LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 500322
SAN DIEGO CA
92150-0322
US

IV. Provider business mailing address

PO BOX 500322
SAN DIEGO CA
92150-0322
US

V. Phone/Fax

Practice location:
  • Phone: 858-751-7556
  • Fax:
Mailing address:
  • Phone: 858-751-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-15126
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17892
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: