Provider Demographics
NPI:1003978909
Name:JANC, GINA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:JANC
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 1:3041 RANCHO LA PRESA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2222
Mailing Address - Country:US
Mailing Address - Phone:619-752-4529
Mailing Address - Fax:
Practice Address - Street 1:3434 GROVE ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1812
Practice Address - Country:US
Practice Address - Phone:619-797-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist