Provider Demographics
NPI:1093069031
Name:GILLARD, TONIKA NICOLE
Entity Type:Individual
Prefix:MS
First Name:TONIKA
Middle Name:NICOLE
Last Name:GILLARD
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 1:250 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 4900
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-3394
Mailing Address - Country:US
Mailing Address - Phone:415-656-0116
Mailing Address - Fax:415-656-0117
Practice Address - Street 1:250 EXECUTIVE PARK BLVD
Practice Address - Street 2:SUITE 4900
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3394
Practice Address - Country:US
Practice Address - Phone:415-656-0116
Practice Address - Fax:415-656-0117
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 85830106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist