Provider Demographics
NPI:1952675118
Name:GORDON, LAUREN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 WRENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7863
Mailing Address - Country:US
Mailing Address - Phone:404-421-9763
Mailing Address - Fax:
Practice Address - Street 1:3125 WRENWOOD CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7863
Practice Address - Country:US
Practice Address - Phone:404-421-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health