Provider Demographics
NPI:1952468332
Name:NICKEL GAYLE, KRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:NICKEL GAYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISSI
Other - Middle Name:
Other - Last Name:GAYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:116 COFFEE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3168
Mailing Address - Country:US
Mailing Address - Phone:912-352-2921
Mailing Address - Fax:912-352-1038
Practice Address - Street 1:635 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5970
Practice Address - Country:US
Practice Address - Phone:912-352-2921
Practice Address - Fax:912-352-1038
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490177551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical