Healthcare Provider Details

I. General information

NPI: 1225711716
Provider Name (Legal Business Name): PRINCESS ROSHELL-GAHAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 SELLERS CT
CHRISTIANA TN
37037-6611
US

IV. Provider business mailing address

3114 SELLERS CT
CHRISTIANA TN
37037-6611
US

V. Phone/Fax

Practice location:
  • Phone: 615-617-0361
  • Fax:
Mailing address:
  • Phone: 615-617-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7919
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: