Individual
MR. GORDON LANE FAISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NA LCMHC
Contact information
Practice address
54 HARRIS PLACE, BRATTLEBORO, VT 05301
(802) 380-0695
Mailing address
PO BOX 6262, BRATTLEBORO, VT 05302
(802) 380-0695
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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