Provider Demographics
NPI:1053072264
Name:GAINES, JALAYNA DICKERSON (LCSW)
Entity Type:Individual
Prefix:
First Name:JALAYNA
Middle Name:DICKERSON
Last Name:GAINES
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 1:2000 E. LAMAR BLVD.
Mailing Address - Street 2:STE. 600 PMB #129
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006
Mailing Address - Country:US
Mailing Address - Phone:817-286-5951
Mailing Address - Fax:
Practice Address - Street 1:2000 E. LAMAR BLVD.
Practice Address - Street 2:STE. 600 PMB #129
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:817-286-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX579121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical