Provider Demographics
NPI:1083805063
Name:GAMBLE, ROSE (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 S NORTHSHORE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7594
Mailing Address - Country:US
Mailing Address - Phone:615-668-8244
Mailing Address - Fax:865-584-5551
Practice Address - Street 1:813 S NORTHSHORE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7594
Practice Address - Country:US
Practice Address - Phone:615-668-8244
Practice Address - Fax:865-584-5551
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional