Individual
JUSTIN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6624 JIMMY CARTER BLVD STE A, PEACHTREE CORNERS, GA 30071-1727
(404) 900-5450
(404) 900-5453
Mailing address
6624 JIMMY CARTER BLVD STE A, PEACHTREE CORNERS, GA 30071-1727
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW005873
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW005873
OTHER
GA
Enumeration date
06/05/2017
Last updated
06/05/2017
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