Provider Demographics
NPI:1235477258
Name:GROSS, EMILY ANN (CAADE MEMBER)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:GROSS
Suffix:
Gender:F
Credentials:CAADE MEMBER
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:277 E ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7925
Mailing Address - Country:US
Mailing Address - Phone:707-889-4809
Mailing Address - Fax:
Practice Address - Street 1:277 E ROBLES AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7925
Practice Address - Country:US
Practice Address - Phone:707-889-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)