Basic Information
Provider Information
NPI: 1215005632
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GABRIELA
FirstName: DAVINA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: PPQA MEDICARE COMPLIANCE UNIT 6 WEST
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber: 3018166308
Practice Location
Address1: 5999 BURKE COMMONS RD
Address2:  
City: BURKE
State: VA
PostalCode: 220152880
CountryCode: US
TelephoneNumber: 7032497200
FaxNumber: 7032497250
Other Information
ProviderEnumerationDate: 12/01/2006
LastUpdateDate: 06/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X0904001886VAY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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