Provider Demographics
NPI:1740855303
Name:GILMORE, ALVIN LOUIS JR (MFT)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:LOUIS
Last Name:GILMORE
Suffix:JR
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 1:212 LAVERNE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4431
Mailing Address - Country:US
Mailing Address - Phone:206-972-9590
Mailing Address - Fax:
Practice Address - Street 1:212 LAVERNE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4431
Practice Address - Country:US
Practice Address - Phone:206-972-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT26015101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor