Provider Demographics
NPI:1023189057
Name:GORDON, MONYCA LYNN (LSW, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:MONYCA
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 PRINCETON ROAD
Mailing Address - Street 2:TRANSITIONAL LIVING
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-645-4554
Mailing Address - Fax:513-863-9882
Practice Address - Street 1:2052 PRINCETON RD
Practice Address - Street 2:TRANSITIONAL LIVING
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4746
Practice Address - Country:US
Practice Address - Phone:513-645-4554
Practice Address - Fax:513-863-9882
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975967101YA0400X
OHS10292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health