Provider Demographics
NPI:1174116016
Name:NORCROSS, GINAMARIE RUSSO (M ED, ED SP)
Entity type:Individual
Prefix:MRS
First Name:GINAMARIE
Middle Name:RUSSO
Last Name:NORCROSS
Suffix:
Gender:F
Credentials:M ED, ED SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2511
Mailing Address - Country:US
Mailing Address - Phone:035-232-8697
Mailing Address - Fax:
Practice Address - Street 1:1001 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2511
Practice Address - Country:US
Practice Address - Phone:352-218-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20647101YM0800X
FLIMT3482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health