Healthcare Provider Details

I. General information

NPI: 1982982138
Provider Name (Legal Business Name): GAIL GONICK-HALLOWS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 B ST STE 1B
SANTA ROSA CA
95401
US

IV. Provider business mailing address

576 B ST STE 1B
SANTA ROSA CA
95401-5269
US

V. Phone/Fax

Practice location:
  • Phone: 707-921-1937
  • Fax: 707-823-5388
Mailing address:
  • Phone: 707-921-1937
  • Fax: 707-823-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: