Provider Demographics
NPI:1255676045
Name:LADSON, GWENDOLYN RENEE (LAPC)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:RENEE
Last Name:LADSON
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GIMBAL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-8522
Mailing Address - Country:US
Mailing Address - Phone:912-227-4973
Mailing Address - Fax:
Practice Address - Street 1:13 GIMBAL CIR
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-8522
Practice Address - Country:US
Practice Address - Phone:912-227-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002441101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor