Provider Demographics
NPI:1922118587
Name:FAITH, GARY CARROLL (LCSW LICENSED CLINIC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:CARROLL
Last Name:FAITH
Suffix:
Gender:M
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:331 22ND AVE NORTH
Mailing Address - Street 2:SUITE 1 GARY FAITH LCSW
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-329-9809
Mailing Address - Fax:615-523-1322
Practice Address - Street 1:331 22ND AVE NORTH
Practice Address - Street 2:SUITE 1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-9809
Practice Address - Fax:615-523-1322
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP6401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0076270OtherBLUE CROSS
TN3692480Medicaid
TN3692480Medicaid