Provider Demographics
NPI:1447871199
Name:GOMEZ, HADASSAH (LPC)
Entity type:Individual
Prefix:
First Name:HADASSAH
Middle Name:
Last Name:GOMEZ
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 1:119 BROOKSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4234
Mailing Address - Country:US
Mailing Address - Phone:803-808-5222
Mailing Address - Fax:
Practice Address - Street 1:119 BROOKSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-4234
Practice Address - Country:US
Practice Address - Phone:803-808-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional