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General NPI Number Information
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NPI Number | 1518738467
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Entity Type | Individual
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Provider Name | GABRIELLA INEZ CORDEIRO HIGGINS AMFT
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Gender | Female
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 2447 SUMMERFIELD RD
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City | SANTA ROSA
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State | CA
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Zip | 95405-7815
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Country | US
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Telephone | 707-800-3948
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 DAMON CT
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City | SANTA ROSA
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State | CA
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Zip | 95401-5336
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Country | US
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Telephone | 781-864-9121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 136464
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License Number State | CA
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