Provider Demographics
NPI:1992983969
Name:GUNN, JONIE P (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JONIE
Middle Name:P
Last Name:GUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JONIE
Other - Middle Name:P
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:116 WELSH PONY TR NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316
Mailing Address - Country:US
Mailing Address - Phone:912-610-3200
Mailing Address - Fax:912-335-3147
Practice Address - Street 1:1763 GA HWY 196
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-335-3226
Practice Address - Fax:912-335-3147
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004154104100000X
GACSW0044921041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2021806812Medicare PIN