Provider Demographics
NPI:1295072338
Name:GAINES, AMY (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:GAINES
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 1:253 PINE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9608
Mailing Address - Country:US
Mailing Address - Phone:601-937-2041
Mailing Address - Fax:855-845-7341
Practice Address - Street 1:225 E MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3833
Practice Address - Country:US
Practice Address - Phone:601-937-2041
Practice Address - Fax:855-845-7341
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC74641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical