Provider Demographics
NPI:1568638344
Name:GAYLE, GENESSA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:GENESSA
Middle Name:NICOLE
Last Name:GAYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GENESSA
Other - Middle Name:NICOLE
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 N SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2003
Mailing Address - Country:US
Mailing Address - Phone:209-808-9649
Mailing Address - Fax:
Practice Address - Street 1:445 N SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2003
Practice Address - Country:US
Practice Address - Phone:209-808-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker