Provider Demographics
NPI:1932710647
Name:GOMEZ, ALLYCE CHRISTINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ALLYCE
Middle Name:CHRISTINE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ALLYCE
Other - Middle Name:CHRISTINE
Other - Last Name:CARNERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2644 30TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3051
Mailing Address - Country:US
Mailing Address - Phone:310-314-6200
Mailing Address - Fax:301-450-2024
Practice Address - Street 1:812 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2714
Practice Address - Country:US
Practice Address - Phone:909-395-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA8584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor