Provider Demographics
NPI:1831493972
Name:GWIRE GARBAYO, NICOLE (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GWIRE GARBAYO
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2445
Mailing Address - Country:US
Mailing Address - Phone:415-494-8010
Mailing Address - Fax:
Practice Address - Street 1:555 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2726
Practice Address - Country:US
Practice Address - Phone:415-494-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist