Provider Demographics
NPI:1538717384
Name:GIFFORD, NANCY OLIVIER (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:OLIVIER
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2303
Mailing Address - Country:US
Mailing Address - Phone:510-283-3277
Mailing Address - Fax:
Practice Address - Street 1:4386 NELSON DR
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-2303
Practice Address - Country:US
Practice Address - Phone:510-283-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS22347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty