Provider Demographics
NPI:1447304472
Name:GURLEY, ELAINE S (MSW)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:S
Last Name:GURLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 GILLIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-3735
Mailing Address - Country:US
Mailing Address - Phone:229-439-0483
Mailing Address - Fax:229-888-5921
Practice Address - Street 1:1706 GILLIONVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-3735
Practice Address - Country:US
Practice Address - Phone:229-439-0483
Practice Address - Fax:229-888-5921
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000157LCSW1041C0700X
GA000225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
80BBBCDMedicare ID - Type Unspecified