Provider Demographics
NPI:1831590165
Name:GAYLORD, KERI SMITH (LCSW)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:SMITH
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WALNUT CROSSING RUN
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-8081
Mailing Address - Country:US
Mailing Address - Phone:904-887-5911
Mailing Address - Fax:336-849-7891
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7804
Practice Address - Country:US
Practice Address - Phone:336-849-7890
Practice Address - Fax:336-849-7891
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0098171041C0700X
NCP009058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC#P009058OtherLICENSE