Provider Demographics
NPI:1356037956
Name:WORNALL, GWENDOLYN CULPEPPER (LPC)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:CULPEPPER
Last Name:WORNALL
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 1:618 TUCKER XING
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-5032
Mailing Address - Country:US
Mailing Address - Phone:601-506-0907
Mailing Address - Fax:
Practice Address - Street 1:3900 LAKELAND DR STE 203
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8853
Practice Address - Country:US
Practice Address - Phone:601-228-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional