Provider Demographics
NPI:1225734072
Name:GORDON, NAKEISHA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:NAKEISHA
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 ELMSWELL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-4933
Mailing Address - Country:US
Mailing Address - Phone:804-901-6261
Mailing Address - Fax:
Practice Address - Street 1:4020 ELMSWELL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4933
Practice Address - Country:US
Practice Address - Phone:804-901-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional