| Doctor Name: | JACQUELYNE GORDON |
| NPI Number: | 1194913665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC2279 |
| Business Practice Address: | 2021 Chaneyville Rd Ste 102 Owings, MD - 207364348 |
| Business Phone Number: | 4102862833 |
| Business Fax Number: | 4102862834 |
| Mailing Address: | Po Box 630973, BALTIMORE |
| State: | MD |
| Postal Code: | 212630973 |
| Phone Number: | 4102862833 |
| Fax Number: | 4102862834 |
| NPI Enumeration Date: | 10/10/2007 |
| NPI Last Update Date: | 12/06/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC2279 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |