Individual
MS. GAY H ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1204 HOLLY ST, ATLANTA, TX 75551-1842
(903) 796-5061
Mailing address
1204 HOLLY ST, ATLANTA, TX 75551-1842
(903) 796-5061
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00276
TX
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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