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General NPI Number Information
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NPI Number | 1144565284
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Entity Type | Individual
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Provider Name | LEEANN ROCHELLE GUMULAUSKAS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 501 GLOUCESTER ST STE 117
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City | BRUNSWICK
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State | GA
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Zip | 31520-7030
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Country | US
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Telephone | 912-244-9919
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Fax |
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Provider Business Mailing Address
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Address Line | 1093 TAMARA DR SE
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City | DARIEN
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State | GA
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Zip | 31305-4257
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Country | US
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Telephone | 715-379-3101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008515
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4949-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC013249
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License Number State | GA
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