Provider Demographics
NPI:1225711716
Name:ROSHELL-GAHAN, PRINCESS (LCSW)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
Last Name:ROSHELL-GAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 SELLERS CT
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-6611
Mailing Address - Country:US
Mailing Address - Phone:615-617-0361
Mailing Address - Fax:
Practice Address - Street 1:3114 SELLERS CT
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:TN
Practice Address - Zip Code:37037-6611
Practice Address - Country:US
Practice Address - Phone:615-617-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical