Provider Demographics
NPI:1093935108
Name:GALLOWAY, RICKEY EUGENE (RRW)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:EUGENE
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4932
Mailing Address - Country:US
Mailing Address - Phone:562-987-5742
Mailing Address - Fax:
Practice Address - Street 1:3125 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4932
Practice Address - Country:US
Practice Address - Phone:562-987-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1989Medicaid