Individual
MS. GABRIELLA GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., L.P.C.
Contact information
Practice address
8309 OFFICE PARK DR, SUITE A, DOUGLASVILLE, GA 30134-6935
(770) 577-2929
(770) 562-2759
Mailing address
PO BOX 52, TEMPLE, GA 30179-0052
(770) 577-2929
(770) 562-2759
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC002714
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022538
VMC PROVIDER #
GA
01
—
2044180
CIGNA PROVIDER #
GA
01
—
7200230
AETNA PROVIDER NUMBER
GA
01
—
PVPB106934
APS PROVIDER #
GA
Enumeration date
11/15/2006
Last updated
07/08/2007
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