Provider Demographics
NPI:1114240033
Name:RINE, GERALD DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DOUGLAS
Last Name:RINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 GARNER LN
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-9556
Mailing Address - Country:US
Mailing Address - Phone:707-339-0303
Mailing Address - Fax:
Practice Address - Street 1:2971 GARNER LN
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-9556
Practice Address - Country:US
Practice Address - Phone:707-339-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health