Provider Demographics
NPI:1164616082
Name:WIMBERLY, GAYLE G (LPC)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:G
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 LAKELAND EAST DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9025
Mailing Address - Country:US
Mailing Address - Phone:601-918-8414
Mailing Address - Fax:
Practice Address - Street 1:582 LAKELAND EAST DR STE C
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9025
Practice Address - Country:US
Practice Address - Phone:601-898-7528
Practice Address - Fax:601-898-7577
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional