Provider Demographics
NPI:1962921437
Name:GILCHREST, ELIZABETH SHANNON (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHANNON
Last Name:GILCHREST
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30639-0157
Mailing Address - Country:US
Mailing Address - Phone:706-246-0733
Mailing Address - Fax:706-246-0722
Practice Address - Street 1:63 SPRINGS STATION DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30639-3063
Practice Address - Country:US
Practice Address - Phone:706-246-0733
Practice Address - Fax:706-246-0722
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0005834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health