Provider Demographics
NPI:1558967067
Name:SOUTH, GABRIEL THOMAS
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:THOMAS
Last Name:SOUTH
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 1:2251 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1814
Mailing Address - Country:US
Mailing Address - Phone:650-513-6500
Mailing Address - Fax:
Practice Address - Street 1:1241 IRWIN ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2838
Practice Address - Country:US
Practice Address - Phone:650-436-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)