Provider Demographics
NPI:1063035293
Name:GORDON, CANDY LYNN (CRM, PRC, CADC I)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:CRM, PRC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-7413
Mailing Address - Country:US
Mailing Address - Phone:971-570-8100
Mailing Address - Fax:
Practice Address - Street 1:3311 NE MLK JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2086
Practice Address - Country:US
Practice Address - Phone:503-206-8856
Practice Address - Fax:503-327-8318
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-P-02101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)