Doctor Name: | MRS. ROGEA VINCETTA GAYMON |
NPI Number: | 1609249598 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | APC004422 |
Business Practice Address: | 211 Bowens Mill Dr Bonaire, GA - 310053148 |
Business Phone Number: | 4789604728 |
Business Fax Number: | |
Mailing Address: | 211 Bowens Mill Dr, BONAIRE |
State: | GA |
Postal Code: | 310053148 |
Phone Number: | 4789604728 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2015 |
NPI Last Update Date: | 03/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | APC004422 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |