Individual
CASEY ANNE GIDCUMB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
290 N D ST STE 700, SAN BERNARDINO, CA 92401-1705
(909) 963-5355
Mailing address
290 N D ST STE 700, SAN BERNARDINO, CA 92401-1705
(909) 963-5355
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
16474
CA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/20/2020
Last updated
06/03/2025
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