Provider Demographics
NPI:1932643806
Name:GINGERICH, JANICE LE'DAWN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LE'DAWN
Last Name:GINGERICH
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 1:140 SYLVESTER RD BLDG 212
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3521
Mailing Address - Country:US
Mailing Address - Phone:619-553-0367
Mailing Address - Fax:619-553-7506
Practice Address - Street 1:140 SYLVESTER RD BLDG 212
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:619-553-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist