Provider Demographics
NPI:1215774450
Name:NEWBY, GWENDOLYN JOANN (LPC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:JOANN
Last Name:NEWBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4996 DAYBREAK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1708
Mailing Address - Country:US
Mailing Address - Phone:706-580-5988
Mailing Address - Fax:
Practice Address - Street 1:2022 15TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1699
Practice Address - Country:US
Practice Address - Phone:706-649-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014806101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor