Provider Demographics
NPI:1316314818
Name:JORDAN-COOLEY, GABRIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:JORDAN-COOLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7428
Mailing Address - Country:US
Mailing Address - Phone:804-677-7641
Mailing Address - Fax:
Practice Address - Street 1:101 E GRACE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1741
Practice Address - Country:US
Practice Address - Phone:804-677-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical