Provider Demographics
NPI:1013680339
Name:VEGA, GABRIELA M (SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:M
Last Name:VEGA
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5346
Mailing Address - Country:US
Mailing Address - Phone:810-294-1230
Mailing Address - Fax:
Practice Address - Street 1:714 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5346
Practice Address - Country:US
Practice Address - Phone:810-294-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health