Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan J Gonsalves, RADT

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1053035402

Ethan J Gonsalves, RADT is an Addiction (Substance Use Disorder) Counselor in San Luis Obispo, California. Licensed in California. Registered with an NPI since 2022.

Licensed in
CA
In the registry since
2022

Practice location Address checks out

34 Prado
San Luis Obispo, CA 93401
Phone: (805) 519-1405
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence R1475210722 (CA)

Record details

NPI number1053035402
Entity typeIndividual (Type 1)
GenderMale
Credentials RADT
Sole proprietorNo
NPI enumeratedSeptember 29, 2022
Last updated in NPPESSeptember 29, 2022
Certification dateSeptember 28, 2022

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