Individual
LANE GORMLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1050 SHILOH RD NW, SUITE 316, KENNESAW, GA 30144-7194
(678) 213-2215
Mailing address
2575 PEACHTREE RD NE, UNIT 23A, ATLANTA, GA 30305-3694
(404) 814-9468
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC005090
GA
101YM0800X
Mental Health Counselor
LPC005090
GA
101YP2500X
Professional Counselor
Primary
LPC005090
GA
Other
Enumeration date
10/22/2009
Last updated
10/22/2009
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