Provider Demographics
NPI:1063228914
Name:MONGE, GABRIELA (MS, NBC-HWC, CWP)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:MONGE
Suffix:
Gender:F
Credentials:MS, NBC-HWC, CWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SOMERSBY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-8086
Mailing Address - Country:US
Mailing Address - Phone:770-906-0026
Mailing Address - Fax:
Practice Address - Street 1:260 SOMERSBY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-8086
Practice Address - Country:US
Practice Address - Phone:770-906-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174H00000X
GAA-3979718171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator