Healthcare Provider Details

I. General information

NPI: 1760326797
Provider Name (Legal Business Name): LAURA GOLLUB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 SCOTT ST
SAN FRANCISCO CA
94115-3004
US

IV. Provider business mailing address

1655 OAK ST
SAN FRANCISCO CA
94117-2013
US

V. Phone/Fax

Practice location:
  • Phone: 301-943-6802
  • Fax:
Mailing address:
  • Phone: 301-943-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number144056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: