Basic Information
| Provider Information | |||||||||
| NPI: | 1376196733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GABRIEL | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | LCMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284126431 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 PROGRESS DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284575001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102590668 | ||||||||
| FaxNumber: | 9102029966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A14518 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | A14969 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.