Provider Demographics
NPI:1245567296
Name:GAINES, VICTOR H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:H
Last Name:GAINES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:145 THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2411
Mailing Address - Country:US
Mailing Address - Phone:615-781-0013
Mailing Address - Fax:615-837-2459
Practice Address - Street 1:225 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3264
Practice Address - Country:US
Practice Address - Phone:931-766-1916
Practice Address - Fax:931-766-4016
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW62751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical