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Individual
MARK GILLOGLY
Active
Individual
MARK GILLOGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16400
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16400
BOARD OF BEHAVIORAL EXAMINERS, STATE OF CA DEPARTMENT OF CONSUMER AFFAIRS
CA
Enumeration date
02/16/2015
Last updated
02/16/2015
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