Provider Demographics
NPI:1124468145
Name:G.O.A.L.S. FOR WOMEN
Entity type:Organization
Organization Name:G.O.A.L.S. FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE/CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-334-0003
Mailing Address - Street 1:1217 DEL PASO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3660
Mailing Address - Country:US
Mailing Address - Phone:916-621-3783
Mailing Address - Fax:888-847-9365
Practice Address - Street 1:1217 DEL PASO BLVD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3660
Practice Address - Country:US
Practice Address - Phone:916-621-3783
Practice Address - Fax:888-847-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 24677251B00000X, 252Y00000X
CA24677251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency