Provider Demographics
NPI:1285243451
Name:JIMMERSON, GABRIELLE MICHELLE (APCC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MICHELLE
Last Name:JIMMERSON
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21951 RIMHURST DR UNIT J
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5971
Mailing Address - Country:US
Mailing Address - Phone:575-921-5364
Mailing Address - Fax:
Practice Address - Street 1:17195 NEWHOPE ST STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4211
Practice Address - Country:US
Practice Address - Phone:657-360-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional