Provider Demographics
NPI:1316094006
Name:LONGMORE GABLE, MARY (MA, LIC PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LONGMORE GABLE
Suffix:
Gender:F
Credentials:MA, LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 PEARCY AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3663
Mailing Address - Country:US
Mailing Address - Phone:304-485-8203
Mailing Address - Fax:
Practice Address - Street 1:601 AVERY ST STE 400
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5111
Practice Address - Country:US
Practice Address - Phone:304-428-6012
Practice Address - Fax:304-428-6031
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9203062000Medicaid