Provider Demographics
NPI:1871202754
Name:TALLEY, GABRIELLE (LPC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 MERCER UNIVERSITY DR STE 110
Mailing Address - Street 2:# 274
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2549
Mailing Address - Country:US
Mailing Address - Phone:404-436-2272
Mailing Address - Fax:
Practice Address - Street 1:1773 WINDCREST DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2549
Practice Address - Country:US
Practice Address - Phone:404-797-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional