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General NPI Number Information
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NPI Number | 1285243451
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Entity Type | Individual
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Provider Name | GABRIELLE MICHELLE JIMMERSON APCC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 17195 NEWHOPE ST STE 205
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4211
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Country | US
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Telephone | 657-360-4329
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Fax |
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Provider Business Mailing Address
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Address Line | 21951 RIMHURST DR UNIT J
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City | LAKE FOREST
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State | CA
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Zip | 92630-5971
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Country | US
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Telephone | 575-921-5364
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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 | APCC6954
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License Number State | CA
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