Provider Demographics
NPI:1073753349
Name:GORDON, DEIDRE MICHELLE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:MICHELLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841B SANDSTONE PL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116-3015
Mailing Address - Country:US
Mailing Address - Phone:505-293-0115
Mailing Address - Fax:
Practice Address - Street 1:3841B SANDSTONE PL SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87116-3015
Practice Address - Country:US
Practice Address - Phone:505-702-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0120411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health