Individual
MR. GORDON LANE FAISON
Active
Individual
MR. GORDON LANE FAISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NA LCMHC
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
068-0000321
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008170
—
VT
Enumeration date
05/11/2007
Last updated
07/08/2007
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