Healthcare Provider Details

I. General information

NPI: 1255507554
Provider Name (Legal Business Name): GABRIEL PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 MAIN ST
EAST POINT GA
30344-6941
US

IV. Provider business mailing address

4371 PLEASANT POINT DR APT G
DECATUR GA
30034-7013
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-0965
  • Fax: 678-904-0964
Mailing address:
  • Phone: 404-579-6473
  • Fax: 678-904-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002724
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY002724
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY002724
License Number StateGA

VIII. Authorized Official

Name: DR. KAMIEKA GABRIEL
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 404-579-6473