Healthcare Provider Details

I. General information

NPI: 1437843000
Provider Name (Legal Business Name): GABRIELLE SELF LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 DALLAS HWY SW STE AND220
MARIETTA GA
30064-2597
US

IV. Provider business mailing address

463 PARK MANOR DR NW
MARIETTA GA
30064-1421
US

V. Phone/Fax

Practice location:
  • Phone: 404-884-8247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017219
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: