Active NPI
Patience Russell-Gordon, LPC-I
- Professional Counselor
- Beaufort, SC
National Provider Identifier
1669879185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5909
- Practice address
- 609 Carteret St
Beaufort, SC 29902-5003 - Phone
- (843) 592-0510
- NPI assigned
- Nov 26, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5909 | SC | Primary |
Addresses
Primary practice location
609 Carteret St
Beaufort, SC 29902-5003
Mailing address
1312 Harrington St
Beaufort, SC 29902-4124
Phone (843) 592-0510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5909 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416960000000",
"number": "1669879185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1312 HARRINGTON ST",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299024124",
"telephone_number": "843-592-0510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 CARTERET ST",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025003",
"telephone_number": "843-592-0510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL-GORDON",
"first_name": "PATIENCE",
"credential": "LPC-I",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-26",
"last_updated": "2014-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "SC",
"license": "5909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.