Provider Demographics
NPI:1821210071
Name:SMITH, GERGORY A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERGORY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 WASHINGTON S
Mailing Address - Street 2:SUITE A2
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8567
Mailing Address - Country:US
Mailing Address - Phone:770-287-1356
Mailing Address - Fax:770-287-1352
Practice Address - Street 1:621 WASHINGTON S
Practice Address - Street 2:SUITE A2
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8567
Practice Address - Country:US
Practice Address - Phone:770-287-1356
Practice Address - Fax:770-287-1352
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical