Provider Demographics
NPI:1336134121
Name:GABRIEL, KAMIEKA O S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAMIEKA
Middle Name:O S
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 PLEASANT POINT DR APT G
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-7013
Mailing Address - Country:US
Mailing Address - Phone:404-579-6473
Mailing Address - Fax:678-904-0964
Practice Address - Street 1:2791 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6941
Practice Address - Country:US
Practice Address - Phone:678-904-0965
Practice Address - Fax:678-904-0964
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002724103TC1900X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101065Medicaid
GA10049656Medicaid