Provider Demographics
NPI:1215082847
Name:GAINES, LAURA ANN (LISW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:GAINES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-0989
Mailing Address - Country:US
Mailing Address - Phone:614-581-0291
Mailing Address - Fax:
Practice Address - Street 1:4641 LEAP CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1175
Practice Address - Country:US
Practice Address - Phone:614-581-0291
Practice Address - Fax:614-777-7366
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI72141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical