Provider Demographics
NPI:1427412162
Name:GORE, MICHEAL G (MSSA, MSW, LISW)
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:G
Last Name:GORE
Suffix:
Gender:M
Credentials:MSSA, MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4237
Mailing Address - Country:US
Mailing Address - Phone:803-467-1263
Mailing Address - Fax:803-774-4378
Practice Address - Street 1:130 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4237
Practice Address - Country:US
Practice Address - Phone:803-467-1263
Practice Address - Fax:803-774-4378
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC67731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical