Provider Demographics
NPI:1760954234
Name:SMITH, GABRIELLE E (LCSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:E
Last Name:SMITH
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 1:600 PEACHTREE PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6899
Mailing Address - Country:US
Mailing Address - Phone:678-200-9732
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:600 PEACHTREE PKWY STE 112
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6899
Practice Address - Country:US
Practice Address - Phone:678-200-9732
Practice Address - Fax:770-995-1959
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0066641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty