Provider Demographics
NPI:1003981051
Name:GORDON, EMILY C (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:C
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 AIKEN ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-8742
Mailing Address - Country:US
Mailing Address - Phone:828-645-1539
Mailing Address - Fax:828-645-1583
Practice Address - Street 1:540 AIKEN RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-8742
Practice Address - Country:US
Practice Address - Phone:828-645-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
562151539OtherTRICARE
NC0436KOtherBCBS
2819765Medicare ID - Type Unspecified