Active NPI
Theadora Gabrielson
- Marriage & Family Therapist
- Marietta, GA
National Provider Identifier
1285063248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT 000279
- Practice address
- 1640 Powers Ferry Rd SE
Marietta, GA 30067-5491 - Phone
- (770) 366-0066
- Fax
- (770) 988-9296
- NPI assigned
- Nov 10, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | AMFT 000279 | GA | Primary |
Addresses
Primary practice location
1640 Powers Ferry Rd SE
Marietta, GA 30067-5491
Mailing address
2688 Ashford Rd NE
Atlanta, GA 30319-3260
Phone (770) 366-0066
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AMFT 000279 | Other | GA | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMFT 000279 | GA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384041600000",
"number": "1285063248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2688 ASHFORD RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303193260",
"telephone_number": "770-366-0066",
"fax_number": "770-216-1947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 POWERS FERRY RD SE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300675491",
"telephone_number": "770-366-0066",
"fax_number": "770-988-9296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GABRIELSON",
"first_name": "THEADORA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-10",
"last_updated": "2013-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "AMFT 000279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "AMFT 000279",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.