Provider Demographics
NPI:1407830615
Name:GAINES, JOVANNA OMARI WILSON (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JOVANNA
Middle Name:OMARI WILSON
Last Name:GAINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOVANNA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3278 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:MOODY AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31699
Mailing Address - Country:US
Mailing Address - Phone:910-425-4443
Mailing Address - Fax:
Practice Address - Street 1:3278 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699
Practice Address - Country:US
Practice Address - Phone:910-394-4700
Practice Address - Fax:910-394-4711
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070002-11041C0700X
OK78931041C0700X
NY0700021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical