Provider Demographics
NPI:1679815104
Name:GAY, JAN L (LCSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:GAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7513
Mailing Address - Country:US
Mailing Address - Phone:251-377-7104
Mailing Address - Fax:
Practice Address - Street 1:202 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7513
Practice Address - Country:US
Practice Address - Phone:251-377-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3515C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker