1255507554 NPI number — GABRIEL PSYCHOLOGICAL SERVICES, INC.

Table of content: (NPI 1255507554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255507554 NPI number — GABRIEL PSYCHOLOGICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GABRIEL PSYCHOLOGICAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255507554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4371 PLEASANT POINT DR APT G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30034-7013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-579-6473
Provider Business Mailing Address Fax Number:
678-904-0964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2791 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-6941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-904-0965
Provider Business Practice Location Address Fax Number:
678-904-0964
Provider Enumeration Date:
05/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GABRIEL
Authorized Official First Name:
KAMIEKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PSYCHOLOGIST
Authorized Official Telephone Number:
404-579-6473

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY002724 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X , with the licence number: PSY002724 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: PSY002724 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10049656 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 101065 . This is a "CENPATICO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 743365513B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 743365513D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 789824000 . This is a "MAGELLAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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