Provider Demographics
NPI:1548229289
Name:CABBAGE, GARY DOUGLAS (LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DOUGLAS
Last Name:CABBAGE
Suffix:
Gender:M
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:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-0533
Mailing Address - Country:US
Mailing Address - Phone:864-723-6690
Mailing Address - Fax:864-888-1310
Practice Address - Street 1:101 S CATHERINE ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-2608
Practice Address - Country:US
Practice Address - Phone:864-723-6690
Practice Address - Fax:864-888-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional