Provider Demographics
NPI:1801509195
Name:SAGE, REBECCA GASKILL (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GASKILL
Last Name:SAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GASKILL
Other - Last Name:GASKILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REBECCA GASKILL
Mailing Address - Street 1:23 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9692
Mailing Address - Country:US
Mailing Address - Phone:731-988-6046
Mailing Address - Fax:
Practice Address - Street 1:26 LAMAR CIR STE 10
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4121
Practice Address - Country:US
Practice Address - Phone:731-988-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical