Provider Demographics
NPI:1285959395
Name:GALLION, MARCIA COLETTE (LCSW16072)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:COLETTE
Last Name:GALLION
Suffix:
Gender:F
Credentials:LCSW16072
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-0343
Mailing Address - Country:US
Mailing Address - Phone:650-438-1994
Mailing Address - Fax:
Practice Address - Street 1:2247 SHELTER CREEK LN
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-6076
Practice Address - Country:US
Practice Address - Phone:650-438-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health