Provider Demographics
NPI:1306411939
Name:BECK, GORDON DEAN (LCMHCA)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:DEAN
Last Name:BECK
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:MR
Other - First Name:GORDON
Other - Middle Name:DEAN
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:2474 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8151
Mailing Address - Country:US
Mailing Address - Phone:336-736-8237
Mailing Address - Fax:
Practice Address - Street 1:614 MORGAN COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8342
Practice Address - Country:US
Practice Address - Phone:336-302-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health