Provider Demographics
NPI:1538811088
Name:GRESHAM, JOI IMAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JOI
Middle Name:IMAN
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JOI
Other - Middle Name:IMAN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 8TH PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-1829
Mailing Address - Country:US
Mailing Address - Phone:205-215-4211
Mailing Address - Fax:
Practice Address - Street 1:301 8TH PL
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:AL
Practice Address - Zip Code:35127-1829
Practice Address - Country:US
Practice Address - Phone:205-215-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical