Provider Demographics
NPI:1619583861
Name:THOMAS, GABRIELLE KRYSTYNA (LCSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:KRYSTYNA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 RIVERCHASE DR APT 1508
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7516
Mailing Address - Country:US
Mailing Address - Phone:229-942-9159
Mailing Address - Fax:
Practice Address - Street 1:5295 RIVERCHASE DR APT 1508
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7516
Practice Address - Country:US
Practice Address - Phone:229-942-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4535C1041C0700X
GACSW0074911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical