Provider Demographics
NPI:1861614190
Name:THOMAS, GINA MICHELLE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 OLYMPIA AVE
Mailing Address - Street 2:APT. D
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-4976
Mailing Address - Country:US
Mailing Address - Phone:831-393-1060
Mailing Address - Fax:
Practice Address - Street 1:399 DRAKE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7504
Practice Address - Country:US
Practice Address - Phone:831-643-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health