Provider Demographics
NPI:1407674377
Name:SPRADLING, GINA RACHELLE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:RACHELLE
Last Name:SPRADLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17250 VAILETTI DR
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3328
Mailing Address - Country:US
Mailing Address - Phone:818-635-2074
Mailing Address - Fax:
Practice Address - Street 1:17250 VAILETTI DR
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3328
Practice Address - Country:US
Practice Address - Phone:818-635-2074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88293103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)