Provider Demographics
NPI:1124031331
Name:GAMBLE, BRASWELL (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:BRASWELL
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:BRASWELL
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-8560
Mailing Address - Country:US
Mailing Address - Phone:912-224-8985
Mailing Address - Fax:912-447-5661
Practice Address - Street 1:23 E 38TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-8560
Practice Address - Country:US
Practice Address - Phone:912-224-8985
Practice Address - Fax:912-447-5661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health