Provider Demographics
NPI:1063682946
Name:GORDON, TEQUITA MELISSA (BSW)
Entity Type:Individual
Prefix:MS
First Name:TEQUITA
Middle Name:MELISSA
Last Name:GORDON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1142
Mailing Address - Country:US
Mailing Address - Phone:615-298-8070
Mailing Address - Fax:
Practice Address - Street 1:3103 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-1142
Practice Address - Country:US
Practice Address - Phone:615-298-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health