MEDICARE: JAMIE GORDON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC006712	GA

General Provider Information

NPI Number	:	1578883823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE GORDON LPC

Provider Business Mailing Address
First Line	:	1727 WRIGHTSBORO RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4049
Country	:	US
Telephone Number	:	706-993-5794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 WRIGHTSBORO RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4049
Country	:	US
Telephone Number	:	706-993-5794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	09/26/2024

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