Individual
MRS. KELLY DENISE GORHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2605 HOLLOW PNE, CONYERS, GA 30094-3982
(770) 940-1792
Mailing address
2605 HOLLOW PNE, CONYERS, GA 30094-3982
(770) 940-1792
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC012546
GA
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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