Provider Demographics
NPI:1306181599
Name:GORDON-GRANADO, KATHLEEN FRANCES (LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:GORDON-GRANADO
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:PO BOX 151162
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-1162
Mailing Address - Country:US
Mailing Address - Phone:971-563-8889
Mailing Address - Fax:
Practice Address - Street 1:4402 KERRYBROOKE DR STE 250
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1421
Practice Address - Country:US
Practice Address - Phone:971-563-8889
Practice Address - Fax:703-841-2750
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005040101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor