Individual
MS. DIANE J GORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
127 LAKE HOUSE RD, POOLER, GA 31322-9710
(912) 713-4684
Mailing address
127 LAKE HOUSE RD, POOLER, GA 31322-9710
(912) 713-4684
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007991
GA
Other
Enumeration date
02/14/2015
Last updated
05/23/2019
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