Provider Demographics
NPI:1811516859
Name:JACOB, GABRIELA C (PSYD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:C
Last Name:JACOB
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6014
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30065-0014
Mailing Address - Country:US
Mailing Address - Phone:239-877-6758
Mailing Address - Fax:
Practice Address - Street 1:5034 BELL DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2637
Practice Address - Country:US
Practice Address - Phone:239-877-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist