Healthcare Provider Details

I. General information

NPI: 1194636589
Provider Name (Legal Business Name): GIDEON HENDRIX LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ALUMNI DR
CLEVELAND GA
30528-1264
US

IV. Provider business mailing address

191 LEGACY DR
DEMOREST GA
30535-5275
US

V. Phone/Fax

Practice location:
  • Phone: 706-348-2428
  • Fax:
Mailing address:
  • Phone: 706-969-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC12576PC
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017170
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: