Provider Demographics
NPI:1700283215
Name:CRETE, GERALD (PHD, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:CRETE
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 HABERDAM TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9529
Mailing Address - Country:US
Mailing Address - Phone:678-612-6984
Mailing Address - Fax:678-473-7972
Practice Address - Street 1:1420 HABERDAM TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9529
Practice Address - Country:US
Practice Address - Phone:678-612-6984
Practice Address - Fax:678-473-7972
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007424101YP2500X
GAMFT001315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional