Provider Demographics
NPI:1548618333
Name:GAMBER, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GAMBER
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 1:607 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-4524
Mailing Address - Country:US
Mailing Address - Phone:443-277-0191
Mailing Address - Fax:
Practice Address - Street 1:2468 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-5062
Practice Address - Country:US
Practice Address - Phone:304-350-1109
Practice Address - Fax:304-350-8741
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2021-01-14
Deactivation Date:2020-12-18
Deactivation Code:
Reactivation Date:2021-01-13
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst