Provider Demographics
NPI:1548887656
Name:LEE, GABRIELLE E (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 FLAGSTAR CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-8407
Mailing Address - Country:US
Mailing Address - Phone:864-903-5516
Mailing Address - Fax:
Practice Address - Street 1:2607 WOODRUFF RD STE E
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3625
Practice Address - Country:US
Practice Address - Phone:864-209-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117422104100000X
NCC0170201041C0700X
SC14538104100000X
GAMSW010333104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker