Provider Demographics
NPI:1356677504
Name:GORMLEY, LANE (LPC)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 PEACHTREE RD NE
Mailing Address - Street 2:UNIT 23A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3694
Mailing Address - Country:US
Mailing Address - Phone:404-814-9468
Mailing Address - Fax:
Practice Address - Street 1:1050 SHILOH RD NW
Practice Address - Street 2:SUITE 316
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7194
Practice Address - Country:US
Practice Address - Phone:678-213-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005090101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health