Provider Demographics
NPI:1841948080
Name:MORTON-STEWART, GERRICA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:GERRICA
Middle Name:
Last Name:MORTON-STEWART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:GERRICA
Other - Middle Name:
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:410 MILLBROOK VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1667
Mailing Address - Country:US
Mailing Address - Phone:859-552-6816
Mailing Address - Fax:
Practice Address - Street 1:7175 MANOR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3109
Practice Address - Country:US
Practice Address - Phone:706-568-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA84-4905399OtherLLC