Provider Demographics
NPI:1124141221
Name:GERKE, ELAINE C (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:C
Last Name:GERKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 THOMPSON BRIDGE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1723
Mailing Address - Country:US
Mailing Address - Phone:770-536-1360
Mailing Address - Fax:770-536-1316
Practice Address - Street 1:2565 THOMPSON BRIDGE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1723
Practice Address - Country:US
Practice Address - Phone:770-536-1360
Practice Address - Fax:770-536-1316
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0008741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical