Individual
JOHNNIE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8471 NEWMAN ST, DOUGLASVILLE, GA 30134-2420
(678) 386-1338
Mailing address
PO BOX 1477, MARIETTA, GA 30061-1477
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC009766
GA
101YM0800X
Mental Health Counselor
Primary
LPC016689
GA
Other
Enumeration date
06/27/2024
Last updated
05/04/2026
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