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Individual

MRS. GABRIELLE JOHANNA IDEN

Active
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Individual

MRS. GABRIELLE JOHANNA IDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LGSW

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
BP00945505
WV
101YA0400X
Addiction (Substance Use Disorder) Counselor
BP00945505
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP00945505
WV BORAD OF SOCIAL WORK
WV
Enumeration date
06/04/2019
Last updated
06/04/2019
About Stedi
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