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General NPI Number Information
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NPI Number | 1003694936
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Entity Type | Individual
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Provider Name | GABRIELLE JOHNSON LGPC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 801 NAEVE CT
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City | ACCOKEEK
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State | MD
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Zip | 20607-2290
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Country | US
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Telephone | 804-943-2316
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Fax |
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Provider Business Mailing Address
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Address Line | 2670 CRAIN HWY STE 501
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City | WALDORF
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State | MD
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Zip | 20601-2819
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Country | US
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Telephone | 804-943-2316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP13549
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License Number State | MD
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