Individual
GABRIELLA MARIE DECENZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7308 BROOKSTONE WAY, SUMMERVILLE, SC 29486-8169
(843) 602-6601
Mailing address
7308 BROOKSTONE WAY, SUMMERVILLE, SC 29486-8169
(843) 602-6601
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
301805
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZCS61339471
BCBS SC
SC
Enumeration date
08/02/2021
Last updated
08/02/2021
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