Provider Demographics
NPI:1508448648
Name:MCBRIDE, JOHN GABRIEL
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GABRIEL
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BECKHAM LN APT 303
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3247
Mailing Address - Country:US
Mailing Address - Phone:803-638-9799
Mailing Address - Fax:
Practice Address - Street 1:714 BECKHAM LN APT 303
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3247
Practice Address - Country:US
Practice Address - Phone:803-638-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor