Provider Demographics
NPI:1184702144
Name:MAYES, GABRIELE (LMFT)
Entity type:Individual
Prefix:
First Name:GABRIELE
Middle Name:
Last Name:MAYES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6784
Mailing Address - Country:US
Mailing Address - Phone:770-558-3365
Mailing Address - Fax:
Practice Address - Street 1:1311 PARK AVE
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6784
Practice Address - Country:US
Practice Address - Phone:770-558-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist