Provider Demographics
NPI:1164557138
Name:GITTINGS, ANNA-MARIE (MA, MFT INTERN)
Entity Type:Individual
Prefix:
First Name:ANNA-MARIE
Middle Name:
Last Name:GITTINGS
Suffix:
Gender:F
Credentials:MA, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 W 25TH ST
Mailing Address - Street 2:#125
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4415
Mailing Address - Country:US
Mailing Address - Phone:563-427-6818
Mailing Address - Fax:562-988-5975
Practice Address - Street 1:100 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4417
Practice Address - Country:US
Practice Address - Phone:562-427-6818
Practice Address - Fax:562-988-5975
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49588OtherMARRAIGE FAMILY THERAPY