Provider Demographics
NPI:1992035737
Name:CALLOZZO, GINA (MC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CALLOZZO
Suffix:
Gender:F
Credentials:MC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 S PRICE RD
Mailing Address - Street 2:109C
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6607
Mailing Address - Country:US
Mailing Address - Phone:480-266-5989
Mailing Address - Fax:
Practice Address - Street 1:1490 S PRICE RD
Practice Address - Street 2:109C
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6607
Practice Address - Country:US
Practice Address - Phone:480-266-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2235101YP2500X
NC53040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional