Provider Demographics
NPI:1245651017
Name:GAUTHIER, DAFNA (LPPC)
Entity type:Individual
Prefix:
First Name:DAFNA
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:LPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581984
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0034
Mailing Address - Country:US
Mailing Address - Phone:916-753-4479
Mailing Address - Fax:
Practice Address - Street 1:225 30TH ST STE 306
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3359
Practice Address - Country:US
Practice Address - Phone:916-753-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA5915102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health