Provider Demographics
NPI:1407475148
Name:GANDY, MARIE A (LCSW,MSW, QIDP, QMHP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:GANDY
Suffix:
Gender:F
Credentials:LCSW,MSW, QIDP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 BICKETT LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-5607
Mailing Address - Country:US
Mailing Address - Phone:708-268-0793
Mailing Address - Fax:
Practice Address - Street 1:443 BICKETT LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-5607
Practice Address - Country:US
Practice Address - Phone:708-268-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11119-1231041C0700X
TX1084861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical