Provider Demographics
NPI:1578295366
Name:VELASQUEZ, GINA LAVONN (MA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LAVONN
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 8TH ST STE S
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6234
Mailing Address - Country:US
Mailing Address - Phone:707-331-0789
Mailing Address - Fax:
Practice Address - Street 1:791 8TH ST STE S
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6234
Practice Address - Country:US
Practice Address - Phone:707-331-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health