Provider Demographics
NPI:1821294349
Name:SOCIAL WORK CONNECTION
Entity Type:Organization
Organization Name:SOCIAL WORK CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:254-405-2702
Mailing Address - Street 1:421 VILLA DR
Mailing Address - Street 2:#209
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7034
Mailing Address - Country:US
Mailing Address - Phone:254-405-2702
Mailing Address - Fax:866-686-9651
Practice Address - Street 1:421 VILLA DR
Practice Address - Street 2:#209
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7034
Practice Address - Country:US
Practice Address - Phone:254-405-2702
Practice Address - Fax:866-686-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33966251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33966OtherSW LICENSE