Provider Demographics
NPI:1295885481
Name:GARDNER, DALE F (MFT)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:F
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 OLD SONOMA RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3708
Mailing Address - Country:US
Mailing Address - Phone:707-259-8200
Mailing Address - Fax:
Practice Address - Street 1:2344 OLD SONOMA RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3708
Practice Address - Country:US
Practice Address - Phone:707-259-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT20049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist