Provider Demographics
NPI:1306198254
Name:GAMBLE, CIJI C (LPC)
Entity Type:Individual
Prefix:
First Name:CIJI
Middle Name:C
Last Name:GAMBLE
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 1:522 ELEANOR ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3710
Mailing Address - Country:US
Mailing Address - Phone:269-903-4535
Mailing Address - Fax:
Practice Address - Street 1:522 ELEANOR ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3710
Practice Address - Country:US
Practice Address - Phone:269-903-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013225101YP2500X
MI6301015313103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional