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General NPI Number Information
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NPI Number | 1245567296
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Entity Type | Individual
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Provider Name | VICTOR H GAINES LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 225 CENTENNIAL AVE
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3264
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Country | US
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Telephone | 931-766-1916
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Fax | 931-766-4016
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Provider Business Mailing Address
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Address Line | 145 THOMPSON LN
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City | NASHVILLE
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State | TN
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Zip | 37211-2411
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Country | US
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Telephone | 615-781-0013
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Fax | 615-837-2459
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW6275
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License Number State | TN
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