Provider Demographics
NPI:1841978103
Name:GABRIEL, KYTAINA (LCSWA)
Entity type:Individual
Prefix:
First Name:KYTAINA
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 HACKBERRY CREEK TRL APT 1127
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0492
Mailing Address - Country:US
Mailing Address - Phone:786-859-0251
Mailing Address - Fax:
Practice Address - Street 1:9723 NORTHCROSS CENTER CT STE L
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7301
Practice Address - Country:US
Practice Address - Phone:704-948-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty