Healthcare Provider Details

I. General information

NPI: 1124047956
Provider Name (Legal Business Name): GINGER VIRGINIA GABRIEL PH.D., M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LEE BERT WAY
CRESTLINE CA
92325
US

IV. Provider business mailing address

580 FOREST SHADE DR. SUITE 10
CRESTLINE CA
92325-4425
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-6968
  • Fax: 909-338-6086
Mailing address:
  • Phone: 909-338-6968
  • Fax: 909-338-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC31925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: