Provider Demographics
NPI:1447081112
Name:GWATHMEY, ANNIE KATHERINE
Entity type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:KATHERINE
Last Name:GWATHMEY
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 1:1827 10TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4523
Mailing Address - Country:US
Mailing Address - Phone:949-933-4485
Mailing Address - Fax:
Practice Address - Street 1:BEIT T'SHUVAH
Practice Address - Street 2:8831 VENICE BLVD.
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:310-204-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)