Provider Demographics
NPI:1982982138
Name:GONICK-HALLOWS, GAIL (MA)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:GONICK-HALLOWS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 B ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5269
Mailing Address - Country:US
Mailing Address - Phone:707-921-1937
Mailing Address - Fax:707-823-5388
Practice Address - Street 1:576 B ST STE 1B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-921-1937
Practice Address - Fax:707-823-5388
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health