Provider Demographics
NPI:1245937192
Name:SAWYER, GWENDOLYN BROWN (LPC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:BROWN
Last Name:SAWYER
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 1:117 KATIE LYNN ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4333
Mailing Address - Country:US
Mailing Address - Phone:229-255-9665
Mailing Address - Fax:
Practice Address - Street 1:117 KATIE LYNN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4333
Practice Address - Country:US
Practice Address - Phone:229-255-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional