Provider Demographics
NPI:1902178593
Name:OLIVEIRA, GAIL REGINA (LPC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:REGINA
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:326 PEAKS LNDG
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5055
Mailing Address - Country:US
Mailing Address - Phone:678-773-5838
Mailing Address - Fax:404-883-2210
Practice Address - Street 1:1218 FAIRBURN RD SW
Practice Address - Street 2:SUITE 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2117
Practice Address - Country:US
Practice Address - Phone:678-773-5838
Practice Address - Fax:404-883-2210
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC006686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133350AMedicaid