Provider Demographics
NPI:1992218531
Name:HARRIS, GABRIELLE (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 BROADWATER DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3871
Mailing Address - Country:US
Mailing Address - Phone:336-327-3817
Mailing Address - Fax:
Practice Address - Street 1:204 MUIRS CHAPEL RD STE 305
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6176
Practice Address - Country:US
Practice Address - Phone:336-542-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health