Provider Demographics
NPI:1740613975
Name:GOSNELL, ESTHER WILSON (LPC, LPCS, LAC)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:WILSON
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:LPC, LPCS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PAULINE
Mailing Address - State:SC
Mailing Address - Zip Code:29374-2918
Mailing Address - Country:US
Mailing Address - Phone:864-764-4047
Mailing Address - Fax:
Practice Address - Street 1:269 S CHURCH ST STE 213
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3412
Practice Address - Country:US
Practice Address - Phone:864-764-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC7449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC00000Medicaid
SCAD10SPMedicaid