Basic Information
| Provider Information | |||||||||
| NPI: | 1245567296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAINES | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 THOMPSON LN | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372112411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157810013 | ||||||||
| FaxNumber: | 6158372459 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CENTENNIAL AVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384643264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317661916 | ||||||||
| FaxNumber: | 9317664016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2009 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LSW6275 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.