Provider Demographics
NPI:1629853726
Name:BLEICHNER, GAIL SIMPSON
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:SIMPSON
Last Name:BLEICHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6717
Mailing Address - Country:US
Mailing Address - Phone:912-398-0317
Mailing Address - Fax:
Practice Address - Street 1:417 ORANGE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6717
Practice Address - Country:US
Practice Address - Phone:912-398-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical