Provider Demographics
NPI:1770795221
Name:GREGORY, GINA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10681 ORANGE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6313
Mailing Address - Country:US
Mailing Address - Phone:909-945-1677
Mailing Address - Fax:
Practice Address - Street 1:10681 ORANGE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6313
Practice Address - Country:US
Practice Address - Phone:909-945-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical