Healthcare Provider Details

I. General information

NPI: 1922577758
Provider Name (Legal Business Name): PATRICIA ANN GORDON LACS, LAC, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRICIA GORDON LACS, LAC, CS

II. Dates (important events)

Enumeration Date: 11/22/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 E WASHINGTON ST
WALTERBORO SC
29488-3919
US

IV. Provider business mailing address

317 SPRINGLAKES ESTATES DR
LYMAN SC
29365-1361
US

V. Phone/Fax

Practice location:
  • Phone: 843-584-7393
  • Fax: 843-977-1711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number809
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number809
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: