Individual
THEADORA GABRIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1640 POWERS FERRY RD SE, MARIETTA, GA 30067-5491
(770) 366-0066
(770) 988-9296
Mailing address
2688 ASHFORD RD NE, ATLANTA, GA 30319-3260
(770) 366-0066
(770) 216-1947
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
AMFT 000279
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AMFT 000279
LICENSE NUMBER
GA
Enumeration date
11/10/2013
Last updated
11/10/2013
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