Provider Demographics
NPI:1811320591
Name:COSTA, GAIL (BS,LADC)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:BS,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3139
Mailing Address - Country:US
Mailing Address - Phone:612-520-9185
Mailing Address - Fax:612-520-0047
Practice Address - Street 1:1500 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3139
Practice Address - Country:US
Practice Address - Phone:612-520-9185
Practice Address - Fax:612-520-0047
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)