Provider Demographics
NPI:1063255446
Name:GERLACH, CC (AMFT)
Entity type:Individual
Prefix:
First Name:CC
Middle Name:
Last Name:GERLACH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 KNOLL DR # 2
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5768
Mailing Address - Country:US
Mailing Address - Phone:925-918-0896
Mailing Address - Fax:
Practice Address - Street 1:2305 S MELROSE DR STE 111
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8789
Practice Address - Country:US
Practice Address - Phone:760-385-8395
Practice Address - Fax:760-820-5061
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist