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General NPI Number Information
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NPI Number | 1922577758
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Entity Type | Individual
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Provider Name | PATRICIA ANN GORDON LACS, LAC, CS
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Gender | Female
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Dates
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Enumeration Date | 11/22/2018
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 361 E WASHINGTON ST
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City | WALTERBORO
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State | SC
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Zip | 29488-3919
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Country | US
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Telephone | 843-584-7393
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Fax | 843-977-1711
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Provider Business Mailing Address
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Address Line | 317 SPRINGLAKES ESTATES DR
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City | LYMAN
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State | SC
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Zip | 29365-1361
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 559
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 559
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 559
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 559
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 809
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License Number State | SC
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