Provider Demographics
NPI:1659025898
Name:PRINCE, GABRIELLE ELAINE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELAINE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GABBY
Other - Middle Name:ELAINE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1510 STUART RD NE STE 119
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5876
Mailing Address - Country:US
Mailing Address - Phone:423-451-8747
Mailing Address - Fax:
Practice Address - Street 1:1510 STUART RD NE STE 119
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5876
Practice Address - Country:US
Practice Address - Phone:423-451-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician