Doctor Name: | MICHELLE LEA GORDON |
NPI Number: | 1316150899 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 4760 |
Business Practice Address: | 100 Dar Dr. Crossnore, NC - 286160249 |
Business Phone Number: | 8287334305 |
Business Fax Number: | 8287331704 |
Mailing Address: | Po Box 249, CROSSNORE |
State: | NC |
Postal Code: | 286160249 |
Phone Number: | 8287334305 |
Fax Number: | 8287331704 |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4760 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |