Provider Demographics
NPI:1821507179
Name:GOURDINE, ANDREA R (MS, LAPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:GOURDINE
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 NORTHWIND BLVD APT L7
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4505
Mailing Address - Country:US
Mailing Address - Phone:1404-245-9560
Mailing Address - Fax:
Practice Address - Street 1:2601 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1445
Practice Address - Country:US
Practice Address - Phone:229-219-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health