Provider Demographics
NPI:1417655820
Name:SMITH, GABRIELLE RAVEN
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:RAVEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CUMBERLAND AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2256
Mailing Address - Country:US
Mailing Address - Phone:757-383-5038
Mailing Address - Fax:
Practice Address - Street 1:6442 FAULKNER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6122
Practice Address - Country:US
Practice Address - Phone:757-384-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical