Provider Demographics
NPI:1669763801
Name:GORLEY, JAMES ANTHONY (LPC- CACII)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:GORLEY
Suffix:
Gender:M
Credentials:LPC- CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GEORGE LAWRENCE WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-8403
Mailing Address - Country:US
Mailing Address - Phone:478-451-9084
Mailing Address - Fax:
Practice Address - Street 1:1776 N JEFFERSON ST NE STE B
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2292
Practice Address - Country:US
Practice Address - Phone:478-451-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2033101YA0400X
GALPC006666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)