Individual provider · Type 1 NPI

Ethan J. Gonsalves, RADT

Addiction (Substance Use Disorder) Counselor · San Luis Obispo, CA

NPI number 1053035402 Active

Practice location

34 Prado
San Luis Obispo, CA 93401

Call (805) 519-1405 Map

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XR1475210722 (CA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1053035402

Ethan J. Gonsalves, RADT's National Provider Identifier is 1053035402, issued on Sep 29, 2022. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in San Luis Obispo, CA. The record was last updated on Sep 29, 2022.