Provider Demographics
NPI:1649969940
Name:HOLDER, GABRIELLE (LICSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 UPTON STREET NW
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1151
Mailing Address - Country:US
Mailing Address - Phone:202-999-5242
Mailing Address - Fax:914-219-1084
Practice Address - Street 1:2938 UPTON STREET NW
Practice Address - Street 2:BLDG 2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1151
Practice Address - Country:US
Practice Address - Phone:202-999-5242
Practice Address - Fax:914-219-1084
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50080704103TA0700X, 103TF0000X, 103TS0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool