Provider Demographics
NPI:1003177866
Name:LUMPKIN- GORDON, MAMIE KHAMALAH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAMIE
Middle Name:KHAMALAH
Last Name:LUMPKIN- GORDON
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Mailing Address - Street 2:#212
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7270
Mailing Address - Country:US
Mailing Address - Phone:407-636-3532
Mailing Address - Fax:321-256-5292
Practice Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Practice Address - Street 2:#212
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7270
Practice Address - Country:US
Practice Address - Phone:407-636-3532
Practice Address - Fax:321-256-5292
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2024-01-04
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Provider Licenses
StateLicense IDTaxonomies
FLSW220591041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker