Provider Demographics
NPI:1467262576
Name:WILLIAMS, GABRIELLE CHRISTINA
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:CHRISTINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 E 3300 S UNIT 1206
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4730
Mailing Address - Country:US
Mailing Address - Phone:520-440-5443
Mailing Address - Fax:
Practice Address - Street 1:4000 S 700 E STE 9
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2581
Practice Address - Country:US
Practice Address - Phone:801-639-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13571978-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health