Provider Demographics
NPI:1609249598
Name:GAYMON, ROGEA VINCETTA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROGEA
Middle Name:VINCETTA
Last Name:GAYMON
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 1:211 BOWENS MILL DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3148
Mailing Address - Country:US
Mailing Address - Phone:478-960-4728
Mailing Address - Fax:
Practice Address - Street 1:211 BOWENS MILL DR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3148
Practice Address - Country:US
Practice Address - Phone:478-960-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004422101YP2500X
GALPC008772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional