Basic Information
| Provider Information | |||||||||
| NPI: | 1164557138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GITTINGS | ||||||||
| FirstName: | ANNA-MARIE | ||||||||
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| Credential: | MA, MFT INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1536 W 25TH ST | ||||||||
| Address2: | #125 | ||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907324415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634276818 | ||||||||
| FaxNumber: | 5629885975 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E WARDLOW RD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908074417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624276818 | ||||||||
| FaxNumber: | 5629885975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 49588 | 01 | CA | MARRAIGE FAMILY THERAPY | OTHER |