Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2827 | GA |
NPI | 1053539742 |
---|---|
Provider Name | Dr. Stacey Gabriel |
First Address | Suwanee, GA 30024-4273 |
Second Address | Duluth, GA 30097-8495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |