Healthcare Provider Details

I. General information

NPI: 1215345376
Provider Name (Legal Business Name): KELLI MARIA GORDY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SUGARLOAF CIR STE 575
DULUTH GA
30097-9804
US

IV. Provider business mailing address

2055 SUGARLOAF CIR STE 575
DULUTH GA
30097-9804
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-7971
  • Fax: 678-534-2045
Mailing address:
  • Phone: 404-999-7971
  • Fax: 678-534-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009486
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: