Provider Demographics
NPI:1356985154
Name:TROUTMAN, GABRIELLE ALEXANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALEXANDRA
Last Name:TROUTMAN
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 1:606 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-2313
Mailing Address - Country:US
Mailing Address - Phone:704-923-5374
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4540
Practice Address - Country:US
Practice Address - Phone:704-734-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0142871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical