Provider Demographics
NPI:1770349896
Name:OVERBY, GREGGA A (LICSW)
Entity type:Individual
Prefix:
First Name:GREGGA
Middle Name:A
Last Name:OVERBY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GREGGA
Other - Middle Name:A
Other - Last Name:GIDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1650 BUENA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-6622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 BUENA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-6622
Practice Address - Country:US
Practice Address - Phone:334-498-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5615C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical