Provider Demographics
NPI:1043403546
Name:GROSS, ERNEST CHARLES JR (LCSW BACS CSSWS)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:CHARLES
Last Name:GROSS
Suffix:JR
Gender:M
Credentials:LCSW BACS CSSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 OLD TOWNE ROAD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2777
Mailing Address - Country:US
Mailing Address - Phone:504-220-4805
Mailing Address - Fax:225-570-2077
Practice Address - Street 1:2645 OLD TOWNE ROAD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2777
Practice Address - Country:US
Practice Address - Phone:504-220-4805
Practice Address - Fax:225-570-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3391104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker