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General NPI Number Information
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NPI Number | 1386356475
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Entity Type | Organization
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Legal Business Name | ANDREA L GOCKLEY PSY D
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 128 ORANGE AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4310
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Country | US
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Telephone | 386-285-8978
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Fax |
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Provider Business Mailing Address
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Address Line | 128 ORANGE AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4310
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Country | US
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Telephone | 386-285-8978
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA GOCKLEY
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Credential | PSYD
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Telephone | 706-490-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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