Provider Demographics
NPI:1760626444
Name:LESTER, GARY RONALD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RONALD
Last Name:LESTER
Suffix:
Gender:M
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:PO BOX1818
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-4164
Mailing Address - Country:US
Mailing Address - Phone:678-447-5063
Mailing Address - Fax:770-775-5118
Practice Address - Street 1:176 INDIAN SPRINGS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2124
Practice Address - Country:US
Practice Address - Phone:678-447-5063
Practice Address - Fax:770-775-5118
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical