Provider Demographics
NPI:1821387259
Name:GUSTAFSON, WINDY KAY (CADCA)
Entity Type:Individual
Prefix:
First Name:WINDY
Middle Name:KAY
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:CADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 KEMPER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4907
Mailing Address - Country:US
Mailing Address - Phone:619-758-1433
Mailing Address - Fax:619-758-9823
Practice Address - Street 1:3340 KEMPER ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4907
Practice Address - Country:US
Practice Address - Phone:619-758-1433
Practice Address - Fax:619-758-9823
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8544Medicaid