Provider Demographics
NPI:1588003388
Name:GORG, ASIA JULIA (PHD, LPC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ASIA
Middle Name:JULIA
Last Name:GORG
Suffix:
Gender:F
Credentials:PHD, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 COLONY WAY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226
Mailing Address - Country:US
Mailing Address - Phone:205-722-3009
Mailing Address - Fax:
Practice Address - Street 1:5414 COLONY WAY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226
Practice Address - Country:US
Practice Address - Phone:205-722-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5297101YM0800X
AL3372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health