Provider Demographics
NPI:1255132692
Name:HOUSE-GASTON, LOREN ASHLEY (MSW)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:ASHLEY
Last Name:HOUSE-GASTON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:ASHLEY
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1603 HEYFORD CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7627
Mailing Address - Country:US
Mailing Address - Phone:404-664-3268
Mailing Address - Fax:
Practice Address - Street 1:1603 HEYFORD CIR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7627
Practice Address - Country:US
Practice Address - Phone:404-664-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker