Doctor Name: | JULIE GORDON |
NPI Number: | 1194908699 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 4270 Brown Rd Croswell, MI - 484229499 |
Business Phone Number: | 8107050479 |
Business Fax Number: | |
Mailing Address: | 4270 Brown Rd, CROSWELL |
State: | MI |
Postal Code: | 484229499 |
Phone Number: | 8107050479 |
Fax Number: | |
NPI Enumeration Date: | 12/07/2007 |
NPI Last Update Date: | 12/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |