Individual
MRS. GABRIELLE JOHANNA IDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
800 EMMETT ROUSCH DR, MARTINSBURG, WV 25401-6313
(304) 901-2070
Mailing address
55 MERIDIAN PKWY, MARTINSBURG, WV 25404-5422
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
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