Provider Demographics
NPI:1215465836
Name:GOMILLION, GEORCOL L (LPC)
Entity type:Individual
Prefix:MS
First Name:GEORCOL
Middle Name:L
Last Name:GOMILLION
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GEORCOL
Other - Middle Name:L
Other - Last Name:GOMILLION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APC
Mailing Address - Street 1:285 W WIEUCA RD NE # 4260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3321
Mailing Address - Country:US
Mailing Address - Phone:404-852-0794
Mailing Address - Fax:
Practice Address - Street 1:285 W WIEUCA RD NE # 4260
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3321
Practice Address - Country:US
Practice Address - Phone:404-852-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health