Provider Demographics
NPI:1902161276
Name:DELAPLANE, GARY WAYNE (MA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:DELAPLANE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 DOE HILL LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2990
Mailing Address - Country:US
Mailing Address - Phone:678-596-9594
Mailing Address - Fax:
Practice Address - Street 1:870 DOE HILL LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2990
Practice Address - Country:US
Practice Address - Phone:678-596-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09024255101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral