Provider Demographics
NPI:1992291330
Name:GALLAGHER, GABRIELLE ELISE (LPC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELISE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ELISE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:36400 WOODWARD AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0913
Mailing Address - Country:US
Mailing Address - Phone:248-629-2799
Mailing Address - Fax:
Practice Address - Street 1:36400 WOODWARD AVE STE 222
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0913
Practice Address - Country:US
Practice Address - Phone:248-629-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223064101YP2500X
MI6401017852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional