Doctor Name: | MS. CHANDRA S. GORDON |
NPI Number: | 1104159060 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADAC; LPC |
License Number: | 14967 |
Business Practice Address: | 1217 Bonita St Grants, NM - 870202103 |
Business Phone Number: | 5052872273 |
Business Fax Number: | 5052872276 |
Mailing Address: | Po Box 3348, MILAN |
State: | NM |
Postal Code: | 870213348 |
Phone Number: | 5052400823 |
Fax Number: | 5052400823 |
NPI Enumeration Date: | 09/10/2009 |
NPI Last Update Date: | 03/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | 14967 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |