Provider Demographics
NPI:1952083503
Name:PACELLA, GWEN JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:JEAN
Last Name:PACELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 DEMERE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5638
Mailing Address - Country:US
Mailing Address - Phone:912-580-0100
Mailing Address - Fax:
Practice Address - Street 1:2463 DEMERE RD STE 209
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5638
Practice Address - Country:US
Practice Address - Phone:912-580-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0085541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical