Provider Demographics
NPI:1669827010
Name:GOLLNICK-LICENIK, APRIL (LMFT)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:GOLLNICK-LICENIK
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 1:1610 EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2608
Mailing Address - Country:US
Mailing Address - Phone:916-900-6805
Mailing Address - Fax:
Practice Address - Street 1:1610 EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-2608
Practice Address - Country:US
Practice Address - Phone:916-359-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF# 81389106H00000X
CALMFT108103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist