Provider Demographics
NPI:1053539742
Name:GABRIEL, STACEY (PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6695 OLDE ATLANTA PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6290 ABBOTTS BRIDGE RD
Practice Address - Street 2:SUITE 501
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8495
Practice Address - Country:US
Practice Address - Phone:404-202-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2827103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool