Gordon, Justin
Gordon, Justin is an sole proprietor health care provider with primary practice located at 6624 Jimmy Carter Blvd Ste A , Peachtree Corners GA 30071-1727. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Gordon, Justin can be contacted via phone (404) 900-5450.Contact Information
Primary practice address
6624 Jimmy Carter Blvd Ste A
Peachtree Corners GA 30071-1727
Phone: (404) 900-5450
Fax: (404) 900-5453
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | CSW005873 | Georgia |
Profile Details
| NPI number | 1265961205 |
|---|---|
| LBN Legal business name | Gordon, Justin |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 5th, 2017 |
| Last updated | Jun 5th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265961205 | NPPES |
| Georgia | Other | CSW005873 | OTHER |
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