Healthcare Provider Details

I. General information

NPI: 1265351613
Provider Name (Legal Business Name): RABBIT HOLE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EMERALD DR SPC 77
VISTA CA
92081-4540
US

IV. Provider business mailing address

200 S EMERALD DR SPC 77
VISTA CA
92081-4540
US

V. Phone/Fax

Practice location:
  • Phone: 808-896-4051
  • Fax:
Mailing address:
  • Phone: 808-896-4051
  • Fax:

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: SARAH MARIE GALLAGHER
Title or Position: LPCC
Credential: LPCC-13935
Phone: 808-896-4051