Individual
GARY CARROLL FAITH
Active
Individual
GARY CARROLL FAITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW LICENSED CLINIC
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
IP640
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076270
BLUE CROSS
TN
05
—
3692480
—
TN
Enumeration date
08/30/2006
Last updated
07/08/2007
Update your record
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