Provider Demographics
NPI:1871642736
Name:GENTRY, ELECTRA UNIKA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELECTRA
Middle Name:UNIKA
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ELECTRA
Other - Middle Name:UNIKA
Other - Last Name:GENTRY-GOODWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4971 HOLLICE CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-8509
Mailing Address - Country:US
Mailing Address - Phone:925-606-5669
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-313-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health