Provider Demographics
NPI:1144610775
Name:GRESHAM CONSULTING GROUP, INC.
Entity Type:Organization
Organization Name:GRESHAM CONSULTING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW-CP, MAC,
Authorized Official - Phone:706-993-5186
Mailing Address - Street 1:PO BOX 15166
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-1166
Mailing Address - Country:US
Mailing Address - Phone:706-993-5186
Mailing Address - Fax:
Practice Address - Street 1:2134 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-5026
Practice Address - Country:US
Practice Address - Phone:706-993-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2457251S00000X
SC10117251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health