Provider Demographics
NPI:1790474492
Name:GILLES, JEANETTE ALDERMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ALDERMAN
Last Name:GILLES
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 1:4480 WOODBERRY CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4487
Mailing Address - Country:US
Mailing Address - Phone:706-627-7345
Mailing Address - Fax:
Practice Address - Street 1:3633 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6549
Practice Address - Country:US
Practice Address - Phone:706-432-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0027771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical