Provider Demographics
NPI:1407517634
Name:PATRICK, GINA NICOLE (RCA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:NICOLE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:RCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14751 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2660
Mailing Address - Country:US
Mailing Address - Phone:530-601-8139
Mailing Address - Fax:
Practice Address - Street 1:470 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3199
Practice Address - Country:US
Practice Address - Phone:530-601-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health