Provider Demographics
NPI:1114687019
Name:JONES, GABRIELLE DENISE (MED, LCMHCA)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:DENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:MED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 TRANQUIL DR SE
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-292-6615
Mailing Address - Fax:
Practice Address - Street 1:2416 BEDGOOD DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8515
Practice Address - Country:US
Practice Address - Phone:252-265-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health