Provider Demographics
NPI:1730393406
Name:BYRD, GLORIA T
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:T
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:TERESA
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1220 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2365
Mailing Address - Country:US
Mailing Address - Phone:404-288-8745
Mailing Address - Fax:
Practice Address - Street 1:254 41ST ST BLDG 40709
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5918
Practice Address - Country:US
Practice Address - Phone:706-787-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0009141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical