Provider Demographics
NPI:1497598395
Name:BOATWRIGHT, GABRIELLIA (LMSW)
Entity type:Individual
Prefix:
First Name:GABRIELLIA
Middle Name:
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:GABRIELLIA
Other - Middle Name:
Other - Last Name:BOATWRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GABBY BOATWRIGHT
Mailing Address - Street 1:433 FOND DU LAC DR
Mailing Address - Street 2:
Mailing Address - City:STONE MTN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-1117
Mailing Address - Country:US
Mailing Address - Phone:843-452-2703
Mailing Address - Fax:
Practice Address - Street 1:433 FOND DU LAC DR
Practice Address - Street 2:
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30088-1117
Practice Address - Country:US
Practice Address - Phone:843-452-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health