Provider Demographics
NPI:1366004053
Name:GORDON, CRAIG A II (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:GORDON
Suffix:II
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N QUEBEC ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3415
Mailing Address - Country:US
Mailing Address - Phone:704-771-5679
Mailing Address - Fax:
Practice Address - Street 1:2001 JEFFERSON DAVIS HWY STE 800
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3603
Practice Address - Country:US
Practice Address - Phone:704-771-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health