Provider Demographics
NPI:1275899007
Name:GANDY, CAROL ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:GANDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 LOS OSOS VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-6408
Mailing Address - Country:US
Mailing Address - Phone:805-234-4715
Mailing Address - Fax:
Practice Address - Street 1:11555 LOS OSOS VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6408
Practice Address - Country:US
Practice Address - Phone:805-234-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist