Provider Demographics
NPI:1689349326
Name:GERRY CRETE, LLC
Entity Type:Organization
Organization Name:GERRY CRETE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CRETE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC LMFT
Authorized Official - Phone:678-251-8462
Mailing Address - Street 1:1420 HABERDAM TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9529
Mailing Address - Country:US
Mailing Address - Phone:678-251-8462
Mailing Address - Fax:
Practice Address - Street 1:309 PIRKLE FERRY RD STE 400
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2545
Practice Address - Country:US
Practice Address - Phone:678-251-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health