Provider Demographics
NPI:1669191490
Name:GAINES, JODIE KAY (LCSW, LCAC)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:KAY
Last Name:GAINES
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:MS
Other - First Name:JODIE
Other - Middle Name:KAY
Other - Last Name:LEASURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARLSON
Mailing Address - Street 1:18352 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:ARGOS
Mailing Address - State:IN
Mailing Address - Zip Code:46501-9714
Mailing Address - Country:US
Mailing Address - Phone:219-307-0668
Mailing Address - Fax:
Practice Address - Street 1:1708 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-2633
Practice Address - Country:US
Practice Address - Phone:574-406-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001775A101YA0400X
IN34011629A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)