Healthcare Provider Details

I. General information

NPI: 1649799347
Provider Name (Legal Business Name): GABRIELLA RICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 QUEEN ANNE CT SE
MABLETON GA
30126-1432
US

IV. Provider business mailing address

2897 N DRUID HILLS RD NE STE 501
ATLANTA GA
30329-3924
US

V. Phone/Fax

Practice location:
  • Phone: 678-215-1238
  • Fax:
Mailing address:
  • Phone: 678-215-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006792
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: