Provider Demographics
NPI:1861600199
Name:ZIMMERLY, GWEN CHERYL (MA)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:CHERYL
Last Name:ZIMMERLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 PINEBOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-9151
Mailing Address - Country:US
Mailing Address - Phone:251-639-0433
Mailing Address - Fax:
Practice Address - Street 1:1048 STANTON RD
Practice Address - Street 2:SUITE F
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4294
Practice Address - Country:US
Practice Address - Phone:251-621-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor