Provider Demographics
NPI:1235833799
Name:GORDON, CARRIE ANNE (AMFT 133512)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANNE
Last Name:GORDON
Suffix:
Gender:F
Credentials:AMFT 133512
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2799
Mailing Address - Country:US
Mailing Address - Phone:714-845-5366
Mailing Address - Fax:
Practice Address - Street 1:1207 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2799
Practice Address - Country:US
Practice Address - Phone:714-845-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133512106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist