Provider Demographics
NPI:1972862308
Name:GORE, CASSIE (LPCC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:325 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1671
Practice Address - Country:US
Practice Address - Phone:606-784-4161
Practice Address - Fax:606-329-8195
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164099101YP2500X
KYLPCPCC00220314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid