Provider Demographics
NPI:1407017072
Name:GAYLE, CATHERINE (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:GAYLE
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111B CORPORATE PARK EAST DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3680
Mailing Address - Country:US
Mailing Address - Phone:706-884-1080
Mailing Address - Fax:706-812-8866
Practice Address - Street 1:111B CORPORATE PARK EAST DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3680
Practice Address - Country:US
Practice Address - Phone:706-884-1080
Practice Address - Fax:706-812-8866
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0024141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514073675AMedicaid