Provider Demographics
NPI:1881373173
Name:GAINES, JILL D (LSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:GAINES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6707
Mailing Address - Country:US
Mailing Address - Phone:513-413-0127
Mailing Address - Fax:
Practice Address - Street 1:1511 CALVARY LN STE 201
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8371
Practice Address - Country:US
Practice Address - Phone:859-869-0041
Practice Address - Fax:859-869-0044
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309494104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker