Provider Demographics
NPI:1346043494
Name:GABRIEL, JACKLINE
Entity type:Individual
Prefix:
First Name:JACKLINE
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JACKLINE
Other - Middle Name:
Other - Last Name:AWAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:739 BENCH LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3952
Mailing Address - Country:US
Mailing Address - Phone:615-347-6749
Mailing Address - Fax:
Practice Address - Street 1:2031 N MOUNT JULIET RD STE 201
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4498
Practice Address - Country:US
Practice Address - Phone:615-438-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health