Provider Demographics
NPI:1760786867
Name:GABRIEL, JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:GABRIEL
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 1:3557 SANDERLING DR SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8576
Mailing Address - Country:US
Mailing Address - Phone:910-409-9763
Mailing Address - Fax:
Practice Address - Street 1:3557 SANDERLING DR SE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8576
Practice Address - Country:US
Practice Address - Phone:910-409-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0069991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical