Provider Demographics
NPI:1326577701
Name:COSTA, GYNA CASSIA DANTAS (LCSW92526)
Entity Type:Individual
Prefix:
First Name:GYNA CASSIA
Middle Name:DANTAS
Last Name:COSTA
Suffix:
Gender:F
Credentials:LCSW92526
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 MISSION GORGE RD STE 139
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1301
Mailing Address - Country:US
Mailing Address - Phone:619-797-5090
Mailing Address - Fax:
Practice Address - Street 1:7465 MISSION GORGE RD STE 139
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1301
Practice Address - Country:US
Practice Address - Phone:619-797-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical