| Constace Gibson, Mft Llc | |
|
2613 Village Side Dr Santa Rosa CA 95405-6849 | |
| (707) 583-9287 | |
| Not Available |
| Full Name | Constace Gibson, Mft Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2613 Village Side Dr, Santa Rosa, California |
| Authorized Official Name and Position | Constance Gibson (OWNER) |
| Authorized Official Contact | 7075839287 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Constace Gibson, Mft Llc Po Box 11746 Olympia WA 98508-1746 Ph: (707) 583-9287 | Constace Gibson, Mft Llc 2613 Village Side Dr Santa Rosa CA 95405-6849 Ph: (707) 583-9287 |
| NPI Number | 1124856364 |
|---|---|
| Provider Enumeration Date | 07/22/2024 |
| Last Update Date | 07/22/2024 |
| Certification Date | 07/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124856364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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