Provider Demographics
NPI:1154806073
Name:MILLINS, GABRIELLE PATRICE CARROLL (LICSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:PATRICE CARROLL
Last Name:MILLINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:PATRICE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:56 OLD MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1436
Mailing Address - Country:US
Mailing Address - Phone:508-331-2524
Mailing Address - Fax:
Practice Address - Street 1:56 OLD MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1436
Practice Address - Country:US
Practice Address - Phone:508-331-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110886-SW-LICSW101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor