Provider Demographics
NPI:1902296924
Name:VENERABLE, GAIL (LPC/CADC-II/ICADC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:VENERABLE
Suffix:
Gender:F
Credentials:LPC/CADC-II/ICADC
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:VENERABLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:235 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3452
Mailing Address - Country:US
Mailing Address - Phone:770-905-1291
Mailing Address - Fax:678-668-7222
Practice Address - Street 1:235 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3452
Practice Address - Country:US
Practice Address - Phone:770-905-1291
Practice Address - Fax:678-668-7222
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACAC-II 1827101YA0400X
GACADC-II 664101YA0400X
GALPC009133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)