Provider Demographics
NPI:1750854709
Name:GAITHER, ADRIAN SIMONE (LPC)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:SIMONE
Last Name:GAITHER
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 1:5714 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1047
Mailing Address - Country:US
Mailing Address - Phone:470-473-5528
Mailing Address - Fax:
Practice Address - Street 1:5714 PHILLIPS DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1047
Practice Address - Country:US
Practice Address - Phone:470-473-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012558101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty