Provider Demographics
NPI:1114934726
Name:CALDWELL-MILLER, GABRIELLA CHANCE (PHD, LPC)
Entity type:Individual
Prefix:MR
First Name:GABRIELLA
Middle Name:CHANCE
Last Name:CALDWELL-MILLER
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2376
Mailing Address - Country:US
Mailing Address - Phone:804-836-6274
Mailing Address - Fax:309-662-6302
Practice Address - Street 1:1045 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2376
Practice Address - Country:US
Practice Address - Phone:804-836-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL509544Medicare UPIN
IL5732048Medicare UPIN
IL62-53657Medicare UPIN
IL226487Medicare UPIN