Andrew Derrick Gordon, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC012296 Issued in GA

Practice address

500 Lanier Ave W
Fayetteville, GA 30214-7636

Phone

(404) 800-4002

Fax

(404) 393-5698

NPI assigned

Jul 14, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Yellow Bridge Therapy Center

  • Community/Behavioral Health Agency
  • Austell, GA
  • NPI 1518617125
  NPD Authorized official
• The Yellow Bridge Therapy Center

  • Professional Counselor
  • Austell, GA
  • NPI 1902698772
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1699347112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7097 SOUTHFACE WAY",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301686361",
            "telephone_number": "770-314-7674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LANIER AVE W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147636",
            "telephone_number": "404-800-4002",
            "fax_number": "404-393-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ANDREW",
        "middle_name": "DERRICK",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David A. Goodman, M.D.
• Jennifer Goodson, NP
• Tere P Goodwin, LPC, NCC
• Gopaul Family LLC
• Kurt Carlton Gopaul, RPSGT,CCSH,RST, RCP
• Priyanka Gorukanti
• David Phillip Gowdy, M.D.
• Marysue C Goza, M.D.
• Sara H. Goza, M.D.
• Wendy Smith Goza, M.D.

• Professional Counselor in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.