Individual
EVAN GANICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
89 OUCHONDER RD, ELMWOOD, TN 38560-4232
(615) 579-6241
Mailing address
89 OUCHONDER RD, ELMWOOD, TN 38560-4232
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
115656
NY
261QM0850X
Adult Mental Health Clinic/Center
Primary
115656
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P-IND4MBYJ6QCTX-00
NASW LIABILITY INSURANCE
NY
Enumeration date
03/01/2022
Last updated
03/01/2022
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